| Revival Psychiatry And Ketamine Clinic | |
|
1220 S Alma School Rd Ste 212 Mesa AZ 85210-2087 | |
| (480) 613-8162 | |
| (480) 900-8654 |
| Full Name | Revival Psychiatry And Ketamine Clinic |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1220 S Alma School Rd Ste 212, Mesa, Arizona |
| Authorized Official Name and Position | Erin Jones (OWNER/PROVIDER) |
| Authorized Official Contact | 4806138162 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revival Psychiatry And Ketamine Clinic 1220 S Alma School Rd Ste 212 Mesa AZ 85210-2087 Ph: (480) 613-8162 | Revival Psychiatry And Ketamine Clinic 1220 S Alma School Rd Ste 212 Mesa AZ 85210-2087 Ph: (480) 613-8162 |
| NPI Number | 1235847286 |
|---|---|
| Provider Enumeration Date | 11/08/2022 |
| Last Update Date | 11/08/2022 |
| Medicare PECOS PAC ID | 4981073178 |
|---|---|
| Medicare Enrollment ID | O20221209002070 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235847286 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Erin Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710568407 PECOS PAC ID: 3274942321 Enrollment ID: I20221209002111 |
| Provider Name | Ashleigh Michelle Mcdonnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023789963 PECOS PAC ID: 8224492434 Enrollment ID: I20230906003147 |
Ohana Kids & Family Kare Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3130 E Baseline Rd Ste 103, Mesa, AZ 85204 Phone: 480-539-7618 Fax: 480-900-8884 | |
True Patriot Consulting, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1134 E University Dr Ste 111, Mesa, AZ 85203 Phone: 480-398-1220 Fax: 480-398-1238 | |
M.g.t Rn Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 7117 E Peralta Cir, Mesa, AZ 85212 Phone: 480-430-0721 | |
Stillpoint Wellness, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2266 S Dobson Rd Ste 200, Mesa, AZ 85202 Phone: 480-280-1996 Fax: 602-532-7649 | |
Cactus Pediatric Orthopaedics, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1500 S Dobson Rd Ste 200, Mesa, AZ 85202 Phone: 480-551-0300 | |
Voyage Medical Primary Care Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1130 W Grove Ave Ste 115, Mesa, AZ 85210 Phone: 480-685-0930 | |
Tripp Family Medicine, P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2830 E Brown Rd, Suite 1, Mesa, AZ 85213 Phone: 480-830-7546 Fax: 480-830-7550 |