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General NPI Number Information
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NPI Number | 1588091532
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Entity Type | Organization
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Legal Business Name | REJUVENATED MINDS, PLLC
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Dates
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Enumeration Date | 10/07/2013
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 3719 BENSON DRIVE
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City | RALEIGH
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State | NC
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Zip | 27609-7324
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Country | US
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Telephone | 919-800-0757
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Fax | 866-626-1755
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Provider Business Mailing Address
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Address Line | 3719 BENSON DR
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City | RALEIGH
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State | NC
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Zip | 27609-7324
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Country | US
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Telephone | 919-800-0757
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Fax | 866-626-1755
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Authorized Official
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Title or Position | SOLE ORGANIZER
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Name | RACHELL DAVIS
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Credential | PMHNP
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Telephone | 919-800-0757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 134272
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License Number State | NC
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