Revitalize Hydration Therapy, LLC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

Legal business name

REVITALIZE HYDRATION THERAPY, LLC

Practice address

885 Liberty Rd Ste 300
Flowood, MS 39232-9006

Phone

(601) 213-0069

NPI assigned

Mar 23, 2020

Last updated

Nov 10, 2020By 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

Jennye Mardis, RN

Title

Staff

Phone

(601) 213-0069

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 14

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.

• Regina Berry, CNP

  • Acute Care Nurse Practitioner
  • Jackson, MS
  • NPI 1154799625
  Medicare reassignment Care Compare group NPD
• Jo P Deal, MD

  • Infectious Disease Physician
  • Jackson, MS
  • NPI 1003826272
  Medicare reassignment Care Compare group NPD
• Amanda Henson Gill, NP-C

  • Family Nurse Practitioner
  • Vicksburg, MS
  • NPI 1598230245
  Medicare reassignment Care Compare group NPD
• Valerie Baughn Morris, FNP-C

  • Family Nurse Practitioner
  • Canton, MS
  • NPI 1265917694
  Medicare reassignment Care Compare group NPD
• Olatunji Jonathan Oluwatade, MD

  • Infectious Disease Physician
  • Vicksburg, MS
  • NPI 1477677458
  Medicare reassignment Care Compare group NPD
• Jessalynn Denton Thurman, FNP

  • Family Nurse Practitioner
  • Florence, MS
  • NPI 1821754631
  Medicare reassignment Care Compare group NPD
• Stacey A. Carter, NP

  • Family Nurse Practitioner
  • Jackson, MS
  • NPI 1528246576
  Medicare reassignment Care Compare group
• Wendi Lee Ann Nopper, NP-C

  • Family Nurse Practitioner
  • Jackson, MS
  • NPI 1124323175
  Medicare reassignment Care Compare group
• Rebecca L Cauthen, ACNP

  • Gerontology Nurse Practitioner
  • Madison, MS
  • NPI 1134589930
  Medicare reassignment NPD
• Deborah G Headley, CFNP

  • Family Nurse Practitioner
  • Jackson, MS
  • NPI 1720314180
  Medicare reassignment NPD
• Amy Catherine Hooker, FNP-C

  • Family Nurse Practitioner
  • Jackson, MS
  • NPI 1386518603
  Medicare reassignment NPD
• Laurie Selman Nimon, NP

  • Family Nurse Practitioner
  • Jackson, MS
  • NPI 1265712145
  Medicare reassignment NPD

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

{
    "created_epoch": "1584921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604966400000",
    "number": "1285261123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "885 LIBERTY RD STE 300",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329006",
            "telephone_number": "601-213-0069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "885 LIBERTY RD STE 300",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329006",
            "telephone_number": "601-213-0069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE HYDRATION THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-23",
        "last_updated": "2020-11-10",
        "certification_date": "2020-10-30",
        "status": "A",
        "authorized_official_last_name": "MARDIS",
        "authorized_official_first_name": "JENNYE",
        "authorized_official_title_or_position": "STAFF",
        "authorized_official_telephone_number": "601-213-0069",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aimee Renaudin, CRNA
• Reservoir Family Medical Clinic, PA
• Resilience Counseling & Recovery Center, LLC
• Responsive Counseling Center
• Mark Owen Rester, M.D.
• George M Reynolds, M.D.
• Melissa N Reynolds, LCSW
• Rebekah Celeste Reynolds, NP-C
• George Jeffrey Rhoden
• Nicole Rhoden, CRNA

• Gerontology Nurse Practitioner in Flowood, MS
• Providers in Flowood, MS by specialty
• Gerontology Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.