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General NPI Number Information
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NPI Number | 1457276743
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Entity Type | Organization
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Legal Business Name | RE.VITALIZE WELLNESS, LLC
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Dates
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Enumeration Date | 08/13/2026
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Last Update Date | 08/13/2026
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Provider Practice Location Address
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Address Line | 1110 COTTONWOOD LN STE 165
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City | IRVING
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State | TX
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Zip | 75038-6117
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Country | US
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Telephone | 817-677-8033
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 COTTONWOOD LN STE 165
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City | IRVING
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State | TX
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Zip | 75038-6117
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Country | US
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Telephone | 817-677-8033
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | KRISTI HARRAL
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Credential | DNP, MSN, MHA, RN
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Telephone | 817-677-8033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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