Revivewave Therapeutics LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

REVIVEWAVE THERAPEUTICS LLC

Doing business as

Revive Integrated Wellness

Practice address

6399 Goodman Rd Ste 105
Olive Branch, MS 38654-7063

Phone

(662) 300-6822

NPI assigned

Jul 8, 2026

Last updated

Jul 8, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jack Chandler Papa, MSN, APRN, FNP-C

Title

Owner / Founder

Phone

(662) 300-6822

Specialties & licenses 2

Addresses

Other names 1

• Revive Integrated Wellness Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Connie Jean Hodge, FNP-BC, PMHNP-BC

  • Family Nurse Practitioner
  • Olive Branch, MS
  • NPI 1891103313
  NPD (past)

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

{
    "created_epoch": "1783468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783468800000",
    "number": "1902724776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6399 GOODMAN RD STE 105",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386547063",
            "telephone_number": "662-300-6822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6399 GOODMAN RD STE 105",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386547063",
            "telephone_number": "662-300-6822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVEWAVE THERAPEUTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-07-08",
        "last_updated": "2026-07-08",
        "certification_date": "2026-07-08",
        "status": "A",
        "authorized_official_last_name": "PAPA",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "CHANDLER",
        "authorized_official_title_or_position": "OWNER / FOUNDER",
        "authorized_official_telephone_number": "662-300-6822",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSN, APRN, FNP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revive Integrated Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Nurse Practitioner in Olive Branch, MS
• Providers in Olive Branch, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2026; 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.