Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Revitaderm PLLC

Organization Registered Nurse · NPI 1518770494

Revitaderm PLLC is a Registered Nurse in Newark, Texas. Registered with an NPI since 2025.

In the registry since
2025
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

110 Cheyenne Trl S
Newark, TX 76071-3202
Phone: (817) 992-5066
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Registered Nurse (primary) Taxonomy 163W00000X

Record details

NPI number1518770494
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Brooke Mackie — Rn · (817) 992-5066
NPI enumeratedJanuary 27, 2025
Last updated in NPPESJanuary 27, 2025
Certification dateJanuary 27, 2025
Mailing addressPo Box 1037, Rhome, TX 76078-1037