MEDICARE: TRANSFORMATIVE HEALTH AND WELLNESS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1063351039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSFORMATIVE HEALTH AND WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	900 E SIX FORKS RD UNIT 522
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-1843
Country	:	US
Telephone Number	:	336-514-3587
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 E SIX FORKS RD UNIT 522
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-1843
Country	:	US
Telephone Number	:	336-514-3587
Fax Number	:

Authorized Official
Title or Position	:	DNP, APRN, FNP-BC, PMHNP-BC
Name	:	DR. KIERA SLADE
Credential	:	APRN
Telephone Number	:	336-514-3587

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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