Revive Health and Wellness of Arkansas, PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

REVIVE HEALTH AND WELLNESS OF ARKANSAS, PLLC

Practice address

8114 Cantrell Rd Ste 201
Little Rock, AR 72227-2504

Phone

(501) 779-8554

Fax

(501) 222-8034

NPI assigned

Aug 11, 2021

Organization subpart

No

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

Authorized official

Name

Lindsey Gillum, APRN

Title

MNG Member

Phone

(501) 779-8554

Specialties & licenses 1

Addresses

Other names 1

• Revive Lifestyle Medicine Doing business as

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lindsey Jane Ponwith, APRN

  • Family Nurse Practitioner
  • Little Rock, AR
  • NPI 1104122803
  Medicare reassignment Care Compare group NPD
• Jourdan Quinn, APRN

  • Family Nurse Practitioner
  • Little Rock, AR
  • NPI 1174910210
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1628640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657238400000",
    "number": "1548935646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8114 CANTRELL RD STE 201",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722272504",
            "telephone_number": "501-779-8554",
            "fax_number": "501-222-8034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8114 CANTRELL RD STE 201",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722272504",
            "telephone_number": "501-779-8554",
            "fax_number": "501-222-8034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE HEALTH AND WELLNESS OF ARKANSAS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-11",
        "last_updated": "2022-07-08",
        "certification_date": "2022-07-08",
        "status": "A",
        "authorized_official_last_name": "GILLUM",
        "authorized_official_first_name": "LINDSEY",
        "authorized_official_title_or_position": "MNG MEMBER",
        "authorized_official_telephone_number": "501-779-8554",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "PracticeFusion",
            "affiliation": "N",
            "endpointDescription": "EMR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8114 Cantrell Rd Ste 201",
            "city": "Little Rock",
            "state": "AR",
            "country_code": "US",
            "postal_code": "722272504",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "CharmEHR",
            "affiliation": "N",
            "endpointDescription": "PHR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8114 Cantrell Rd Ste 201",
            "city": "Little Rock",
            "state": "AR",
            "country_code": "US",
            "postal_code": "722272504",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Revive Lifestyle Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Revive Lifestyle Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Restoring Love & Care Services
• Retina Associates, P.a.
• Retina Specialists of Arkansas, P.a.
• Pooja Ratna Revanna, MD
• Roderick Revels
• Revive Hearing Center of Arkansas
• Emory Reyes
• Gloria Reyes
• Kelli Reyes, PT
• Zuleima L Reyes

• Family Nurse Practitioner in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Family Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.