REVITALIZE HYDRATION THERAPY LLC NPI 1285261123

NPI Information

NPI: 1285261123
Provider Name: REVITALIZE HYDRATION THERAPY, LLC
Classification: Nurse Practitioner - 363LG0600X
Entity Type: Organization

Specialization: Gerontology

CLIA Number: 25D2172355

Address:
885 LIBERTY RD STE 300
FLOWOOD, MS
ZIP 39232
Phone: (601) 213-0069
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REVITALIZE HYDRATION THERAPY, LLC is a gerontology nurse practitioner in Flowood, MS. REVITALIZE HYDRATION THERAPY, LLC NPI is 1285261123. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

885 LIBERTY RD STE 300
FLOWOOD, MS
ZIP 39232-006
Phone: (601) 213-0069

The provider's authorized official is Jennye Mardis .
The authorized official title is Staff and has the following contact phone number (601) 213-0069.

The CLIA number assigned to this NPI record is 25D2172355 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/23/2020 and was last updated on 11/10/2020.

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	363LG0600X	Nurse Practitioner	Gerontology			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: 4/28/2024

NPI Synchronization or Removal

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