Revived Vitality

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

REVIVED VITALITY

Practice address

1301 48TH Ave N # a-2
Myrtle Beach, SC 29577-5427

Phone

(843) 580-3694

NPI assigned

Aug 16, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Jennings Michael Perry, DNPNPI 1851684674

Title

Owner/Provider

Phone

(843) 855-2299

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Jennings Michael Perry, DNP

  • Primary Care Nurse Practitioner
  • Myrtle Beach, SC
  • NPI 1851684674
  NPD Authorized official

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

{
    "created_epoch": "1692144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692144000000",
    "number": "1992588750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 BALD EAGLE DR STE 201",
            "city": "MARCO ISLAND",
            "state": "FL",
            "postal_code": "341452731",
            "telephone_number": "843-855-2299",
            "fax_number": "843-353-2564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 48TH AVE N # A-2",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295775427",
            "telephone_number": "843-580-3694"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "606 Bald Eagle Dr Ste 201",
            "address_purpose": "LOCATION",
            "city": "Marco Island",
            "state": "FL",
            "postal_code": "341452731",
            "country_code": "US",
            "telephone_number": "843-855-2299",
            "fax_number": "843-353-2564",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REVIVED VITALITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-16",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-16",
        "status": "A",
        "authorized_official_last_name": "PERRY",
        "authorized_official_first_name": "JENNINGS",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "843-855-2299",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2023; 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.