Revive Wellness L.L.C.

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

Legal business name

REVIVE WELLNESS L.L.C.

Practice address

8302 Nottingham Pkwy
Louisville, KY 40222-5540

Phone

(502) 468-5003

NPI assigned

Dec 7, 2023

Organization subpart

No

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

Authorized official

Name

Michelle Chambers, NP

Title

Nurse Practitioner

Phone

(941) 626-1031

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1701907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701907200000",
    "number": "1487421673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8302 NOTTINGHAM PKWY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402225540",
            "telephone_number": "502-468-5003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8302 NOTTINGHAM PKWY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402225540",
            "telephone_number": "502-468-5003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE WELLNESS L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-07",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A",
        "authorized_official_last_name": "CHAMBERS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "941-626-1031",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "2083B0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tisa Marie Revels, SA-C, KCSA
• Danielle Revert, APRN
• Lynde Revert, LCSW
• Jaymie Barker Reves, OT
• Revive Counseling & Wellness, LLC
• Robert John Revolt, PTA
• Tasha Revolus
• Yeneisy Reyes Diaz, LMT
• Carlos David Reyes Sarmiento, MD
• Cindia Reyes

• Adult Health Nurse Practitioner in Louisville, KY
• Providers in Louisville, KY by specialty
• Adult Health Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; 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.