Revitalize Psychiatry, PLLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

REVITALIZE PSYCHIATRY, PLLC

Practice address

11220 Elm LN Ste 203-9
Charlotte, NC 28277-0715

Phone

(704) 459-2181

Fax

(704) 533-9516

NPI assigned

Jan 13, 2023

Organization subpart

No

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

Authorized official

Name

Casey Watson, PMHNPNPI 1164890281

Title

Owner

Phone

(704) 459-2181

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

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

• Casey Marie Watson, FNP, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Charlotte, NC
  • NPI 1164890281
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1673568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680393600000",
    "number": "1720792799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8022 PROVIDENCE RD STE 500-229",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282779719",
            "telephone_number": "704-459-2181",
            "fax_number": "704-533-9516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11220 ELM LN STE 203-9",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282770715",
            "telephone_number": "704-459-2181",
            "fax_number": "704-533-9516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE PSYCHIATRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-13",
        "last_updated": "2023-04-02",
        "certification_date": "2023-04-02",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "CASEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-459-2181",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2023; 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.