Active NPI
Jose Felix Revollo
- Psychiatric/Mental Health Nurse Practitioner
- Fort Washington, MD
National Provider Identifier
1013553502
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- R239041
- Practice address
- 703 Clamor CT
Fort Washington, MD 20744-5170 - Phone
- (201) 757-4005
- NPI assigned
- Nov 20, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R239041 | MD | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | R239041 | MD | Primary |
Addresses
Primary practice location
703 Clamor CT
Fort Washington, MD 20744-5170
Mailing address
703 Clamor CT
Fort Washington, MD 20744-5170
Phone (201) 757-4005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R239041 | MD | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574208000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783468800000",
"number": "1013553502",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "703 CLAMOR CT",
"city": "FORT WASHINGTON",
"state": "MD",
"postal_code": "207445170",
"telephone_number": "201-757-4005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "703 CLAMOR CT",
"city": "FORT WASHINGTON",
"state": "MD",
"postal_code": "207445170",
"telephone_number": "201-757-4005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVOLLO",
"first_name": "JOSE",
"middle_name": "FELIX",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-11-20",
"last_updated": "2026-07-08",
"certification_date": "2026-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MD",
"license": "R239041",
"primary": false
},
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "MD",
"license": "R239041",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Washington, MD
- Natoya Rosemarie Reid, DMD, MBA
- Rejuvenate Counseling
- Renew Physical Therapy and Wellness Center, LLC
- Renewing Minds, Restoring Hope LLC
- Revivamind Behavioral Health Services, LLC.
- Revolutionary Inventions, Inc.
- Tatiana Carolina Reyes, CMI CERTIFIED
- Andreya E Richardson
- Erika Richardson, MSW, LICSW
- Kimberly Rienecke, P.A.-C
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.