Vitality Ageless Center LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

VITALITY AGELESS CENTER LLC

Practice address

5100 Poplar Ave FL 27
Memphis, TN 38137-2701

Phone

(770) 614-6266

NPI assigned

Feb 14, 2025

Last updated

Feb 14, 2025By 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

Jessica Jones

Title

Ao

Phone

(215) 292-0275

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Vitality Ageless Center LLC

  • Multi-Specialty Clinic/Center
  • Suwanee, GA
  • NPI 1730657271

  6800135872

  Same PAC ID

Locations

Practitioners 4

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.

• Aldridge Smith Westrich, FNP

  • Family Nurse Practitioner
  • Bartlett, TN
  • NPI 1316457179
  Medicare reassignment NPD
• Vickie M Johnson, NURSE PRACTITIONER

  • Nurse Practitioner
  • Novi, MI
  • NPI 1922338086

  TN

  Medicare reassignment NPD
• Mark Steven Grimsley, MD

  • Family Medicine Physician
  • Duluth, GA
  • NPI 1861729816
  NPD
• Laureano Antonio Santiago

  • Medical Physician Assistant
  • Jacksonville, FL
  • NPI 1043896368
  NPD (past)

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

{
    "created_epoch": "1739491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739491200000",
    "number": "1326843277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 PEACHTREE INDUSTRIAL BLVD STE 1201",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 POPLAR AVE FL 27",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381372701",
            "telephone_number": "770-614-6266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY AGELESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-14",
        "last_updated": "2025-02-14",
        "certification_date": "2025-02-14",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "AO",
        "authorized_official_telephone_number": "215-292-0275"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Visionworks Inc (Viisionworks)
• Visionworks, Inc. (Visionworks)
• Visionworks, Inc. (Visionworks)
• Shreya Visvanathan
• Vitae Health Medical Tennessee PLLC
• Vitatrace Testing, LLC
• Vivid Eyes Vision Care LLC
• David Warren Vo
• Hieu Vo, M.D.
• Tran Vo

• Family Nurse Practitioner in Memphis, TN
• Providers in Memphis, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 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.