Organization
REVITALIZED WELLNESS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTI LYNN ROSS FNP-C (OWNER)
(251) 979-9825
Entity
Organization
Contact information
Practice address
326 E 8TH ST APT 206, SIOUX FALLS, SD 57103-7038
(605) 423-7557
(605) 305-1175
Mailing address
401 E 8TH ST STE 214-7054, SIOUX FALLS, SD 57103-7011
(605) 423-7557
(605) 305-1175
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
08/11/2020
Last updated
03/07/2024
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