Revive Wellness, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

REVIVE WELLNESS, PC

Practice address

850 W Main St
Rogersville, TN 37857-3663

Phone

(423) 500-0266

NPI assigned

Feb 17, 2020

Last updated

Feb 17, 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

Crystal Dyer, MDNPI 1841485018

Title

President

Phone

(423) 552-1531

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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.

• Crystal Shanelle Dyer, M.D.

  • Sports Medicine (Family Medicine) Physician
  • Rogersville, TN
  • NPI 1841485018
  NPD Authorized official

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

{
    "created_epoch": "1581897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581897600000",
    "number": "1932732187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 W MAIN ST",
            "city": "ROGERSVILLE",
            "state": "TN",
            "postal_code": "378573663",
            "telephone_number": "423-500-0266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 W MAIN ST",
            "city": "ROGERSVILLE",
            "state": "TN",
            "postal_code": "378573663",
            "telephone_number": "423-500-0266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE WELLNESS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-17",
        "last_updated": "2020-02-17",
        "certification_date": "2020-02-17",
        "status": "A",
        "authorized_official_last_name": "DYER",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "423-552-1531",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "44247",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Qualified Home Health Care Associates, LLC
• Lakita Mae Ramsey, NP-C
• Molly Ramsey, DDS
• Jesse L Reed, PHARMD
• Beth Ann Reuschel, PT
• Etta Renee Rich
• Megan Danielle Rimer, FNP
• Tyler J Ringley, DPT
• Mariah M Rivera
• Tammy Lorraine Robbins, BSW

• Family Medicine Physician in Rogersville, TN
• Providers in Rogersville, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2020; 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.