Revive Concierge & Wellness PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

REVIVE CONCIERGE & WELLNESS PLLC

Practice address

2961 Crouse LN
Burlington, NC 27215-8833

Phone

(336) 266-0518

NPI assigned

Mar 27, 2023

Organization subpart

No

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

Authorized official

Name

Chrystal Dannette Gunn GammonNPI 1073165148

Title

Owner

Phone

(336) 266-0518

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 1

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

• Chrystal Dannette Gunn Gammon, NP

  • Family Nurse Practitioner
  • Burlington, NC
  • NPI 1073165148

  NC

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1679875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766016000000",
    "number": "1942904818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 116",
            "city": "SEDALIA",
            "state": "NC",
            "postal_code": "273420116",
            "telephone_number": "336-266-7899",
            "fax_number": "336-234-1020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2961 CROUSE LN",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272158833",
            "telephone_number": "336-266-0518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE CONCIERGE & WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-27",
        "last_updated": "2025-12-18",
        "certification_date": "2025-12-18",
        "status": "A",
        "authorized_official_last_name": "GAMMON",
        "authorized_official_first_name": "CHRYSTAL",
        "authorized_official_middle_name": "DANNETTE GUNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-266-0518"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Residential Treatment Services
• Residential Treatment Services of Alamance
• Residential Treatment Services of Alamance, Inc.
• Resources for the Carolinas
• Revive Beauty & Drip Lounge, PLLC
• Raquel Rey
• Stephanie Reyes Soto
• Rha Behavioral Health NC LLC
• Rha Behavioral Health NC LLC
• Rha Health Services Inc

• All providers in Burlington, NC
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 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.