Tisa Marie Revels, SA-C, KCSA

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

SA029 Issued in KY

Practice address

4001 Kresge Way
Suite 200
Louisville, KY 40207-4640

Phone

(502) 895-1995

Fax

(502) 895-6479

NPI assigned

Feb 15, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: trevels8478@bhkydirect.com

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456963200000",
    "number": "1750424859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 950248",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402950248",
            "telephone_number": "502-253-1035",
            "fax_number": "502-253-1037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 KRESGE WAY",
            "address_2": "SUITE 200",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074640",
            "telephone_number": "502-895-1995",
            "fax_number": "502-895-6479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVELS",
        "first_name": "TISA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "SA-C, KCSA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-15",
        "last_updated": "2016-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "KY",
            "license": "SA029",
            "primary": false
        },
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "KY",
            "license": "SA029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard T Reul, D.C.
• Barton H Reutlinger, M.D.
• Revelation Counseling Center
• Caitlin Revell, MS, BCBA, LBA
• Carol Revell, RPH
• Danielle Revert, APRN
• Lynde Revert, LCSW
• Jaymie Barker Reves, OT
• Revive Counseling & Wellness, LLC
• Revive Wellness L.L.C.

• Surgical Assistant in Louisville, KY
• Providers in Louisville, KY by specialty
• Surgical Assistant in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2016; 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.