Revivify Biologics

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

REVIVIFY BIOLOGICS

Doing business as

Revivify Biologics

Practice address

4100 Heritage Ave
Grapevine, TX 76051-5714

Phone

(817) 886-4319

NPI assigned

Nov 20, 2017

Last updated

Nov 20, 2017By 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

Ellen Rose Becker, AGNP

Title

Nurse Practioner

Phone

(817) 886-4319

Specialties & licenses 1

Addresses

Other names 1

• Revivify Biologics Doing business as

Locations

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

{
    "created_epoch": "1511136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511136000000",
    "number": "1952815466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 MAIN ST STE 110",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "760342931",
            "telephone_number": "817-886-4319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 HERITAGE AVE",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760515714",
            "telephone_number": "817-886-4319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVIFY BIOLOGICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-20",
        "last_updated": "2017-11-20",
        "status": "A",
        "authorized_official_last_name": "BECKER",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "NURSE PRACTIONER",
        "authorized_official_telephone_number": "817-886-4319",
        "authorized_official_credential": "AGNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revivify Biologics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Nurse Practitioner in Grapevine, TX
• Providers in Grapevine, TX by specialty
• Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2017; 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.