MEDICARE: GATEWAY CHARLOTTE WELLNESS LLC

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	363L00000X	Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1881316891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAY CHARLOTTE WELLNESS LLC

Provider Business Mailing Address
First Line	:	8936 NORTHPOINTE EXECUTIVE PARK DRIVE
Second Line	:	SUITE 240/260
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078
Country	:	US
Telephone Number	:	980-236-9244
Fax Number	:

Provider Business Practice Location Address
First Line	:	8936 NORTHPOINTE EXECUTIVE PARK DRIVE
Second Line	:	SUITE 240/260
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078
Country	:	US
Telephone Number	:	980-236-9244
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	LUCINDA OKYERE AGBEWALI
Credential	:	DNP, FNP-C,PMHNP-BC
Telephone Number	:	980-236-9244

Provider Enumeration Date	:	09/15/2022
Last Update Date	:	12/16/2025

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