Provider Demographics
NPI:1760050504
Name:INTERNAL VITALITY, LLC
Entity Type:Organization
Organization Name:INTERNAL VITALITY, LLC
Other - Org Name:INTERNAL VITALITY HEALTH, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-BC,PMHNP-BC
Authorized Official - Phone:770-268-0968
Mailing Address - Street 1:848 N RAINBOW BLVD # 9143
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1103
Mailing Address - Country:US
Mailing Address - Phone:770-268-0968
Mailing Address - Fax:
Practice Address - Street 1:400 S. 4TH ST
Practice Address - Street 2:SUITE 500 - #325
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-6207
Practice Address - Country:US
Practice Address - Phone:770-268-0968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1477223Medicaid
MN1942693346Medicaid
AK1691647Medicaid
OK200599210AMedicaid