Revitaderm PLLC
Registered Nurse · Newark, TX
Practice location
110 Cheyenne Trl SNewark, TX 76071-3202
- Phone
- (817) 992-5066
NPI record
- NPI
- 1518770494
- Entity type
- Organization (Type 2)
- Enumeration date
- January 27, 2025
- Last updated
- January 27, 2025
- Certified
- January 27, 2025
- Organization subpart
- No
Specialties & taxonomy codes
| Taxonomy | Code | License | State |
|---|---|---|---|
| Registered Nurse Primary | 163W00000X |
— | — |
Mailing address
PO Box 1037Rhome, TX 76078-1037
- Phone
- (817) 992-5066
Authorized official
- Name
- Brooke Ashley Mackie, PART OWNER
- Title
- RN
- Phone
- (817) 992-5066
About Revitaderm PLLC
Revitaderm PLLC is a healthcare organization registered in the NPI registry with the primary taxonomy Registered Nurse (code 163W00000X). The practice location is 110 Cheyenne Trl S, Newark, TX 76071-3202. The NPI number 1518770494 was assigned on January 27, 2025 and the record was last updated on January 27, 2025.
The authorized official for this organization is Brooke Ashley Mackie, PART OWNER, RN.
Frequently asked questions
What is the NPI number of Revitaderm PLLC?
The NPI number is 1518770494.
What is the phone number of Revitaderm PLLC?
The phone number listed for the practice location is (817) 992-5066.
Where is Revitaderm PLLC located?
110 Cheyenne Trl S, Newark, TX 76071-3202.
What is the taxonomy code for Revitaderm PLLC?
The primary taxonomy code is 163W00000X – Registered Nurse.
Is this information correct?
All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.