Renova Wellness & Aesthetics LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

RENOVA WELLNESS & AESTHETICS LLC

Practice address

808 S Walton Blvd Ste 2
Bentonville, AR 72712-6235

Phone

(479) 593-3020

Fax

(479) 341-9337

NPI assigned

May 8, 2026

Last updated

Sep 15, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brant Kwyzla

Title

Owner

Phone

(479) 225-1750

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1778198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789430400000",
    "number": "1407783764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5101 S SLOAN CIR",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727584617",
            "telephone_number": "479-225-1750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 S WALTON BLVD STE 2",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727126235",
            "telephone_number": "479-593-3020",
            "fax_number": "479-341-9337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENOVA WELLNESS & AESTHETICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-05-08",
        "last_updated": "2026-09-15",
        "certification_date": "2026-09-15",
        "status": "A",
        "authorized_official_last_name": "KWYZLA",
        "authorized_official_first_name": "BRANT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-225-1750"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Bentonville, AR
• Providers in Bentonville, AR by specialty
• Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.