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REJUVENATED HEALTH & WELLNESS
NPI 1063000479
Nurse Practitioner in Fort Mohave, AZ

Active since January 02, 2021CLIA 03D2248610 · Waiver
5221 S HIGHWAY 95 STE 13, FORT MOHAVE, AZ 86426(928) 234-7572 Get Directions Write a Review

NPPES record last updated: July 6, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jul 6, 2022, Jan 4, 2021, Jan 2, 2021 (3 updates tracked since 2021).

About Rejuvenated Health & Wellness NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

REJUVENATED HEALTH & WELLNESS (NPI 1063000479) is a healthcare organization registered as a nurse practitioner in Fort Mohave, Arizona and active in the NPI registry since January 2021. The organization holds a CLIA Waiver certificate valid through January 13, 2028 and lists Dayna Blake, Fnp-bc, as its authorized official.

NPPES Registry Identity

NPI1063000479
Entity TypeOrganization
Primary Taxonomy363L00000X
Legal Business NameREJUVENATED HEALTH & WELLNESS
Location Address5221 S HIGHWAY 95 STE 13Fort Mohave, AZ 86426-9244
Mailing AddressPo Box 10837Fort Mohave, AZ 86427-0837 · (928) 201-8289
Phone(928) 234-7572
Organization SubpartYesParent: Nippies
Authorized OfficialDayna BlakeFnp-bc · (928) 201-8289
Enumeration DateJanuary 2, 2021
Last NPPES UpdateJuly 6, 20223 updates tracked since enumeration
NPPES CertifiedJuly 6, 2022
✔ NPI 1063000479 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
5221 S HIGHWAY 95 STE 13, Fort Mohave, AZ 86426
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Other Names 1

Doing Business AsRejuvenated Health & Wellness

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 03D2248610

Rejuvenated Health & Wellness · Fort Mohave, AZ
Active · expires Jan 13, 2028
CLIA Number03D2248610
Laboratory TypeIndependent
Certificate Effective DateJanuary 14, 2026
Certificate Expiration DateJanuary 13, 2028
Laboratory DirectorDayna Blake
Laboratory Phone(928) 201-8289
Laboratory LocationRejuvenated Health & Wellness5221 Highway 95 Ste 13, Fort Mohave, AZ 86426
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Rejuvenated Health & Wellness's NPI number?

The NPI number for Rejuvenated Health & Wellness is 1063000479. It was assigned to this organization in the NPPES registry on January 2, 2021.

Where is Rejuvenated Health & Wellness located?

Rejuvenated Health & Wellness is located at 5221 S Highway 95 Ste 13, Fort Mohave, AZ 86426. The listed phone number is (928) 234-7572.

What is Rejuvenated Health & Wellness's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Does Rejuvenated Health & Wellness hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 03D2248610) is associated with this NPI, valid through January 13, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Rejuvenated Health & Wellness was last updated on July 6, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.