Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

PROVIDENCE PEDIATRIC FUNCTIONAL MEDICINE, PLLC
NPI 1710810437
Clinic/Center - Primary Care in Asheboro, NC

Q: 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.

Active since June 03, 2026

610 N FAYETTEVILLE ST STE 102, ASHEBORO, NC 27203(336) 233-7882 Get Directions Write a Review

NPPES record added: August 1, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 1, 2026, Jun 6, 2026 (2 updates tracked since 2026).

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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 lists Nicole Anderson, Owner/authorized Offician, as its authorized official.

NPPES Registry Identity

NPI1710810437

Entity TypeOrganization

Primary Taxonomy261QP2300X

Legal Business NamePROVIDENCE PEDIATRIC FUNCTIONAL MEDICINE, PLLC

Location Address610 N FAYETTEVILLE ST STE 102Asheboro, NC 27203-4671

Mailing Address610 N Fayetteville St Ste 102Asheboro, NC 27203-4671 · (336) 233-7882

Phone(336) 233-7882

Organization SubpartNo

Authorized OfficialNicole AndersonOwner/authorized Offician · (336) 233-7882

Enumeration DateJune 3, 2026

Last NPPES UpdateAugust 1, 20262 updates tracked since enumeration

NPPES CertifiedAugust 1, 2026

✔ NPI 1710810437 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities

Taxonomy Code261QP2300X

Also ListedNurse Practitioner · PediatricsTaxonomy 363LP0200X

610 N FAYETTEVILLE ST STE 102, Asheboro, NC 27203

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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.

When was this NPI record last updated?

The NPPES record for Providence Pediatric Functional Medicine, PLLC was last updated on August 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.