Healthcare Provider Details

I. General information

NPI: 1932082559
Provider Name (Legal Business Name): REJUVATOUR PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 CHERRYVILLE RD
SHELBY NC
28150-3625
US

IV. Provider business mailing address

734 CHERRYVILLE RD
SHELBY NC
28150-3625
US

V. Phone/Fax

Practice location:
  • Phone: 704-477-3941
  • Fax: 980-268-4377
Mailing address:
  • Phone: 704-477-3941
  • Fax: 980-268-4377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MIRANDA B KILBY
Title or Position: OWNER
Credential: DNP
Phone: 704-214-2487