NPIMap

Organization Active NPI

Revitalist

  • Community/Behavioral Health Agency
  • Knoxville, TN
National Provider Identifier
1073168241
Registry record updated Mar 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
REVITALIST
Practice address
10608 Flickenger LN
Knoxville, TN 37922-3485
Phone
(865) 392-6262
NPI assigned
Aug 5, 2019
Last updated
Mar 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kathryn Walker, CRNANPI 1447671235
Title
Principal Employee
Phone
(865) 392-6262

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Counseling PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC1900X
Community/Behavioral Health Agency 251S00000X Primary
Infusion Therapy Clinic/Center 261QI0500X
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

10608 Flickenger LN
Knoxville, TN 37922-3485

Mailing address

10608 Flickenger LN
Knoxville, TN 37922-3485

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210527000088 TN Part B Supplier - Clinic/Group Practice 6800295650 Receives reassigned benefits from 6 practitioners
Practice locations: Johnson City, TN; Knoxville, TN
O20211202000426 FL Part B Supplier - Clinic/Group Practice 6800295650 Receives reassigned benefits from 3 practitioners
Practice locations: Clearwater, FL

National Provider Directory

National Provider Directory

Locations

13307 Magisterial Dr
Louisville, KY 40223
Phone (502) 386-6501

4833 Rugby Ave
Ste 600
Bethesda, MD 20814
Phone (865) 392-6262

1418 E Millbrook Rd
Raleigh, NC 27609
Phone (919) 850-9111

5715 Uptain Rd
Ste 200
Chattanooga, TN 37411
Phone (423) 504-0085

2 Red Bush Ct
Johnson City, TN 37601
Phone (423) 283-4958

110 E Mountcastle Dr
Johnson City, TN 37601
Phone (423) 430-5492

8639 Mayland Dr
Ste 102
Richmond, VA 23294
Phone (804) 993-3039

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741305600000",
    "number": "1073168241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10608 FLICKENGER LN",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379223485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10608 FLICKENGER LN",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379223485",
            "telephone_number": "865-392-6262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-05",
        "last_updated": "2025-03-07",
        "certification_date": "2025-03-07",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_title_or_position": "PRINCIPAL EMPLOYEE",
        "authorized_official_telephone_number": "865-392-6262",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.