Revive Skin and Wound PLLC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Legal business name

REVIVE SKIN AND WOUND PLLC

Practice address

116 Round Keep LN
Mooresville, NC 28117-8091

Phone

(704) 727-6153

Fax

(213) 559-9971

NPI assigned

Dec 30, 2025

Organization subpart

No

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

Authorized official

Name

Mrs. Jennifer Marie Hull, PA-CNPI 1437154093

Title

Owner/Provider

Phone

(704) 727-6153

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Marie Hull, PA-C

  • Physician Assistant
  • Mooresville, NC
  • NPI 1437154093
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1767052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767052800000",
    "number": "1144186404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 ROUND KEEP LN",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178091",
            "telephone_number": "704-727-6153",
            "fax_number": "213-559-9971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 ROUND KEEP LN",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178091",
            "telephone_number": "704-727-6153",
            "fax_number": "213-559-9971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE SKIN AND WOUND PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-12-30",
        "last_updated": "2025-12-30",
        "certification_date": "2025-12-30",
        "status": "A",
        "authorized_official_last_name": "HULL",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "704-727-6153",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 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.