# REVITALIZED WELLNESS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104682590
- **Authorized official:** CHARMEKA LIPSCOMB (OWNER)
- **Authorized official phone:** (972) 838-0652

## Contact information

- **Practice address:** 1043 MEADOW RUN DR, DUNCANVILLE, TX 75137-3599
- **Practice address phone:** (972) 838-0652
- **Mailing address:** 539 W COMMERCE ST \# 4182, DALLAS, TX 75208-1953

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/23/2024
- **Last updated:** 02/23/2024