Healthcare Provider Details

I. General information

NPI: 1497644124
Provider Name (Legal Business Name): VITALITY CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 ROYCE CT
CHARLOTTE NC
28277-4610
US

IV. Provider business mailing address

3540 TORINGDON WAY STE 200
CHARLOTTE NC
28277-4650
US

V. Phone/Fax

Practice location:
  • Phone: 763-228-2704
  • Fax:
Mailing address:
  • Phone: 763-228-2704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LEANN SIMS
Title or Position: CEO
Credential:
Phone: 763-228-2704