Reviveme Healthcare, PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

REVIVEME HEALTHCARE, PLLC

Practice address

2637 Fairmont Dr,
Grand Prairie, TX 75052-4009

Phone

(817) 964-8349

NPI assigned

Feb 5, 2024

Organization subpart

No

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

Authorized official

Name

Amanda Tejera, NURSE PRACTITIONERNPI 1427689108

Title

Managing Member

Phone

(817) 964-8349

Specialties & licenses 1

Addresses

Practitioners 1

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

• Amanda Jo Tejera

  • Family Nurse Practitioner
  • Coppell, TX
  • NPI 1427689108
  NPD Authorized official

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

{
    "created_epoch": "1707091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707091200000",
    "number": "1801659453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 E. DEBBIE LANE",
            "address_2": "SUITE 102, #1525",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760633376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2637 FAIRMONT DR,",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750524009",
            "telephone_number": "817-964-8349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVEME HEALTHCARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-05",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-03",
        "status": "A",
        "authorized_official_last_name": "TEJERA",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "817-964-8349",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Primary Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2024; 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.