Revered-Holistic Healthcare LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R194691 Issued in MD

Legal business name

REVERED-HOLISTIC HEALTHCARE LLC

Doing business as

Revered Holistic Healthcare LLC

Practice address

9861 Broken Land Pkwy Ste 100
Columbia, MD 21046-3031

Phone

(443) 621-2203

Fax

(410) 381-0216

NPI assigned

May 24, 2018

Organization subpart

No

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

Authorized official

Name

Adetutu Awodipe, FNPNPI 1386157857

Title

Owner

Phone

(443) 621-2203

Specialties & licenses 1

Addresses

Other names 1

• REVERED HOLISTIC HEALTHCARE LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Revered-Holistic Healthcare LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Columbia, MD
  • NPI 1205525334

  O20180802000064

  Same enrollment

Tax ID family

Revered Holistic Healthcare LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Revered-Holistic Healthcare LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Columbia, MD
  • NPI 1205525334
  NPD tax ID

Locations

Practitioners 1

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

• Adetutu Awodipe, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Columbia, MD
  • NPI 1386157857

  Multi-Specialty

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1527120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1700377876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4218 SUMMER SHADE WAY",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211174872",
            "telephone_number": "443-621-2203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9861 BROKEN LAND PKWY STE 100",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210463031",
            "telephone_number": "443-621-2203",
            "fax_number": "410-381-0216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVERED-HOLISTIC HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-24",
        "last_updated": "2025-09-11",
        "certification_date": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "AWODIPE",
        "authorized_official_first_name": "ADETUTU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-621-2203",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R194691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "REVERED HOLISTIC HEALTHCARE LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "REVERED HOLISTIC HEALTHCARE LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy Marlene Respondek, DDS
• Lauren Restaino, CRNP
• Restore & Thrive LLC.
• Cristina Restrepo-Harner
• Revered-Holistic Healthcare LLC
• Revive Clinic LLC
• Revolution Sports Medicine
• Jeanine Paulette Sioson Reyes-Bautista, M.D.
• Camila Reyes-Loayza
• Samantha Reyes

• Family Nurse Practitioner in Columbia, MD
• Providers in Columbia, MD by specialty
• Family Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.