Active NPI
Charlie Lee Revay
- Community Health Worker
- St Augustine, FL
National Provider Identifier
1730465360
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- MA 58964
- Practice address
- 6550 State Road 13 N
St Augustine, FL 32092-2020 - Phone
- (904) 563-6716
- NPI assigned
- Oct 27, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | MA 58964 | FL | Primary |
Addresses
Primary practice location
6550 State Road 13 N
St Augustine, FL 32092-2020
Mailing address
6550 State Road 13 N
St Augustine, FL 32092-2020
Phone (904) 563-6716
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA 58964 | FL | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319673600000",
"number": "1730465360",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6550 STATE ROAD 13 N",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320922020",
"telephone_number": "904-563-6716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6550 STATE ROAD 13 N",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320922020",
"telephone_number": "904-563-6716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVAY",
"first_name": "CHARLIE",
"middle_name": "LEE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-27",
"last_updated": "2011-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "FL",
"license": "MA 58964",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.