RENEW RESTORE REVISE PSYCHIATRIC SERVICES, LLC
NPI 1891516324
Psychiatry & Neurology - Psychiatry in Palm Coast, FL

Q: What is Renew Restore Revise Psychiatric Services, LLC's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.

Active since October 17, 2024

25 FLORIDA PARK DR N STE E, PALM COAST, FL 32137(386) 585-2144(386) 206-5386 Get Directions Write a Review

NPPES record last updated: October 1, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Renew Restore Revise Psychiatric Services, Llc NPPES

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

RENEW RESTORE REVISE PSYCHIATRIC SERVICES, LLC (NPI 1891516324) is a healthcare organization registered as a psychiatry in Palm Coast, Florida and active in the NPI registry since October 2024. The organization lists Shinika Clark, Owner, as its authorized official.

NPPES Registry Identity

NPI1891516324

Entity TypeOrganization

Primary Taxonomy2084P0800X

Legal Business NameRENEW RESTORE REVISE PSYCHIATRIC SERVICES, LLC

Location Address25 FLORIDA PARK DR N STE EPalm Coast, FL 32137-3806

Mailing AddressPo Box 45St Augustine, FL 32085-0045 · (386) 585-2144

Phone(386) 585-2144

Fax(386) 206-5386

Organization SubpartNo

Authorized OfficialShinika ClarkOwner · (386) 585-2144

Enumeration DateOctober 17, 2024

Last NPPES UpdateOctober 1, 2025

NPPES CertifiedOctober 1, 2025

✔ NPI 1891516324 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · PsychiatryAllopathic & Osteopathic Physicians

Taxonomy Code2084P0800X

Definition

A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.

25 FLORIDA PARK DR N STE E, Palm Coast, FL 32137

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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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Renew Restore Revise Psychiatric Services, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Renew Restore Revise Psychiatric Services, LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Shinika Clark, NP, PMHNP

Nurse Practitioner

NPI 1417679176

1190 PELICAN BAY DR
Daytona Beach, FL 32119

(386) 206-8069

✔ PECOS✔ Accepts Medicare29 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Renew Restore Revise Psychiatric Services, LLC's NPI number?

The NPI number for Renew Restore Revise Psychiatric Services, LLC is 1891516324. It was assigned to this organization in the NPPES registry on October 17, 2024.

Where is Renew Restore Revise Psychiatric Services, LLC located?

Renew Restore Revise Psychiatric Services, LLC is located at 25 Florida Park Dr N Ste E, Palm Coast, FL 32137. The listed phone number is (386) 585-2144.

What is Renew Restore Revise Psychiatric Services, LLC's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.

Is Renew Restore Revise Psychiatric Services, LLC enrolled in Medicare?

Yes. Renew Restore Revise Psychiatric Services, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Renew Restore Revise Psychiatric Services, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Renew Restore Revise Psychiatric Services, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Renew Restore Revise Psychiatric Services, LLC was last updated on October 1, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months 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.