REVITALIST LLC NPI 1073168241

NPI Information

NPI: 1073168241
Provider Name: REVITALIST, LLC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

CLIA Number: 44D2249257

Address:
10608 FLICKENGER LN
KNOXVILLE, TN
ZIP 37922
Phone: (865) 392-6262
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REVITALIST, LLC is a multi-specialty clinic center in Knoxville, TN. REVITALIST, LLC NPI is 1073168241. The provider is registered as an organization entity type.

The provider's business location address is:

10608 FLICKENGER LN
KNOXVILLE, TN
ZIP 37922-485
Phone: (865) 392-6262

The provider's authorized official is Kathryn Walker .
The authorized official title is Principal Employee and has the following contact phone number (865) 392-6262.

The CLIA number assigned to this NPI record is 44D2249257 - other - wellness clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/5/2019 and was last updated on 3/14/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QI0500X	Clinic/Center	Infusion Therapy			No
2	261QM1300X	Clinic/Center	Multi-Specialty			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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