PROVIDENCE PEDIATRIC FUNCTIONAL MEDICINE, PLLC
NPI 1710810437
Clinic/Center - Primary Care in Asheboro, NC
About Providence Pediatric Functional Medicine, Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PROVIDENCE PEDIATRIC FUNCTIONAL MEDICINE, PLLC (NPI 1710810437) is a healthcare organization registered as a primary care in Asheboro, North Carolina and active in the NPI registry since June 2026. The organization holds a CLIA Waiver certificate valid through August 30, 2028 and lists Nicole Anderson, Owner/authorized Offician, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Accepted Insurance
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 34D2349926
Providence Pediatric Functional Medicine, PLLC · Asheboro, NCOther Providers at the Same Location NPPES
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
ASHEBORO, NC 27203
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Providence Pediatric Functional Medicine, PLLC's NPI number?
The NPI number for Providence Pediatric Functional Medicine, PLLC is 1710810437. It was assigned to this organization in the NPPES registry on June 3, 2026.
Where is Providence Pediatric Functional Medicine, PLLC located?
Providence Pediatric Functional Medicine, PLLC is located at 610 N Fayetteville St Ste 102, Asheboro, NC 27203. The listed phone number is (336) 233-7882.
What is Providence Pediatric Functional Medicine, PLLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Does Providence Pediatric Functional Medicine, PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 34D2349926) is associated with this NPI, valid through August 30, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Providence Pediatric Functional Medicine, PLLC accept?
Health plans from Blue Cross and Blue Shield of NC list Providence Pediatric Functional Medicine, PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Providence Pediatric Functional Medicine, PLLC was last updated on September 18, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 52 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Providence Pediatric Functional Medicine, Pllc · NPI 1710810437
Primary Care organization in Asheboro, North Carolina. Organization record, active in the CMS NPPES registry since June 3, 2026.
## Identity
- **NPI:** 1710810437 (Entity type: Organization)
- **Enumerated:** June 3, 2026
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Nicole Anderson, OWNER/AUTHORIZED OFFICIAN
## Practice location
- **Address:** 610 N FAYETTEVILLE ST STE 102, Asheboro, NC 27203-4671
- **Phone:** (336) 233-7882
## Record status
- **NPPES last updated:** September 18, 2026
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1710810437) · Data from the CMS NPPES public registry.