Healthcare Provider Details

I. General information

NPI: 1457276743
Provider Name (Legal Business Name): RE.VITALIZE WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 COTTONWOOD LN STE 165
IRVING TX
75038-6117
US

IV. Provider business mailing address

1110 COTTONWOOD LN STE 165
IRVING TX
75038-6117
US

V. Phone/Fax

Practice location:
  • Phone: 817-677-8033
  • Fax:
Mailing address:
  • Phone: 817-677-8033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTI HARRAL
Title or Position: CO-OWNER
Credential: DNP, MSN, MHA, RN
Phone: 817-677-8033