Revive Beauty & Drip Lounge, PLLC

Primary specialty

Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X

Legal business name

REVIVE BEAUTY & DRIP LOUNGE, PLLC

Practice address

906 S Main St
Burlington, NC 27215-5757

Phone

(336) 935-1240

Fax

(336) 234-1020

NPI assigned

Mar 27, 2023

Last updated

Apr 18, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Chrystal Gammon, NPNPI 1073165148

Title

Owner/Operator

Phone

(434) 429-2383

Specialties & licenses 2

Addresses

Practitioners 2

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.

• Chrystal Dannette Gunn Gammon, NP

  • Family Nurse Practitioner
  • Burlington, NC
  • NPI 1073165148
  NPD Authorized official
• Lee Anthony Dudley, DO

  • Emergency Medicine Physician
  • Chicago, IL
  • NPI 1215960026
  NPD

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

{
    "created_epoch": "1679875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681776000000",
    "number": "1174226146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 116",
            "city": "SEDALIA",
            "state": "NC",
            "postal_code": "273420116",
            "telephone_number": "336-266-7899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 S MAIN ST",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272155757",
            "telephone_number": "336-935-1240",
            "fax_number": "336-234-1020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE BEAUTY & DRIP LOUNGE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-27",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A",
        "authorized_official_last_name": "GAMMON",
        "authorized_official_first_name": "CHRYSTAL",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "434-429-2383",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renew Hair Loss Solutions
• Residential Treatment Services
• Residential Treatment Services of Alamance
• Residential Treatment Services of Alamance, Inc.
• Resources for the Carolinas
• Revive Concierge & Wellness PLLC
• Raquel Rey
• Stephanie Reyes Soto
• Rha Behavioral Health NC LLC
• Rha Behavioral Health NC LLC

• Infusion Therapy Clinic/Center in Burlington, NC
• Providers in Burlington, NC by specialty
• Infusion Therapy Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.