REVITALIZED WELLNESS NPI 1104682590

NPI Information

  • NPI: 1104682590
  • Provider Name: REVITALIZED WELLNESS
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Organization
  • Address: 1043 MEADOW RUN DR
    DUNCANVILLE, TX
    ZIP 75137
  • Phone: (972) 838-0652

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NPI Details

REVITALIZED WELLNESS is a psychiatric/mental health nurse practitioner in Duncanville, TX. REVITALIZED WELLNESS NPI is 1104682590. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1043 MEADOW RUN DR
DUNCANVILLE, TX
ZIP 75137-599
Phone: (972) 838-0652

The provider's authorized official is Charmeka Lipscomb .
The authorized official title is Owner and has the following contact phone number (972) 838-0652.

The enumeration date for this NPI number is 2/23/2024 and was last updated on 2/23/2024.

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
1363LP0808XNurse PractitionerPsychiatric/Mental HealthYes

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: 3/30/2025

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