Provider Demographics
NPI:1932082559
Name:REJUVATOUR PLLC
Entity type:Organization
Organization Name:REJUVATOUR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:KILBY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:704-214-2487
Mailing Address - Street 1:734 CHERRYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3625
Mailing Address - Country:US
Mailing Address - Phone:704-477-3941
Mailing Address - Fax:980-268-4377
Practice Address - Street 1:734 CHERRYVILLE RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3625
Practice Address - Country:US
Practice Address - Phone:704-477-3941
Practice Address - Fax:980-268-4377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care