Active NPI
Revival Wellness Group LLC
- Clinical Social Worker
- Indianapolis, IN
National Provider Identifier
1942117155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Legal business name
- REVIVAL WELLNESS GROUP LLC
- Practice address
- 11216 Fall Creek Rd Ste 102
Indianapolis, IN 46256-9406 - Phone
- (814) 282-5489
- NPI assigned
- Aug 25, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kaylee Durnell, LCSW
- Title
- Owner
- Phone
- (814) 282-5489
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
11216 Fall Creek Rd Ste 102
Indianapolis, IN 46256-9406
Mailing address
7264 S Woodrow Dr
Pendleton, IN 46064-9102
Phone (814) 282-5489
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1787616000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1788393600000",
"number": "1942117155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7264 S WOODROW DR",
"city": "PENDLETON",
"state": "IN",
"postal_code": "460649102",
"telephone_number": "814-282-5489"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11216 FALL CREEK RD STE 102",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462569406",
"telephone_number": "814-282-5489"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "REVIVAL WELLNESS GROUP LLC",
"organizational_subpart": "NO",
"enumeration_date": "2026-08-25",
"last_updated": "2026-09-03",
"certification_date": "2026-09-03",
"status": "A",
"authorized_official_last_name": "DURNELL",
"authorized_official_first_name": "KAYLEE",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "814-282-5489",
"authorized_official_credential": "LCSW"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.