Revive & Remedy, LLC

Primary specialty

Point of ServiceTaxonomy code 305S00000X

Legal business name

REVIVE & REMEDY, LLC

Practice address

2851 Shelby St
Bartlett, TN 38134-4509

Phone

(901) 335-8541

Fax

(901) 425-9685

NPI assigned

Aug 25, 2021

Organization subpart

No

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

Authorized official

Name

Terri Trichel Wallace-Basken, FNP

Title

Owner

Phone

(901) 335-8541

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1629849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643760000000",
    "number": "1528735602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2851 SHELBY ST",
            "city": "BARTLETT",
            "state": "TN",
            "postal_code": "381344509",
            "telephone_number": "901-842-1480",
            "fax_number": "901-425-9685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2851 SHELBY ST",
            "city": "BARTLETT",
            "state": "TN",
            "postal_code": "381344509",
            "telephone_number": "901-335-8541",
            "fax_number": "901-425-9685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE & REMEDY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-25",
        "last_updated": "2022-02-02",
        "certification_date": "2022-02-02",
        "status": "A",
        "authorized_official_last_name": "WALLACE-BASKEN",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "TRICHEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "901-335-8541",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen P Reed, LCSW
• Elisheva Reese, FNP
• Regenerex Pharma, Inc.
• Regional Homemakers, LLC
• Rehabcare Group East, LLC (RehabCare)
• Revive Behavioral Health Clinic
• Revive Ketamine Clinic, PLLC
• Jessica Marie Reyes, LPC
• Marilyn Young Reynolds, RRT
• RHC Imaging Center

• Point of Service in Bartlett, TN
• Providers in Bartlett, TN by specialty
• Point of Service in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2022; 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.