| Revive Wellness And Aesthetics Llc | |
|
110a S Mlk Jr Dr Indianola MS 38751-2622 | |
| (662) 445-2213 | |
| (662) 445-2214 |
| Full Name | Revive Wellness And Aesthetics Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 110a S Mlk Jr Dr, Indianola, Mississippi |
| Authorized Official Name and Position | Emily Aust (CFNP/OWNER) |
| Authorized Official Contact | 6624452213 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Wellness And Aesthetics Llc 110a S Mlk Jr Dr Indianola MS 38751-2622 Ph: (662) 445-2213 | Revive Wellness And Aesthetics Llc 110a S Mlk Jr Dr Indianola MS 38751-2622 Ph: (662) 445-2213 |
| NPI Number | 1669291308 |
|---|---|
| Provider Enumeration Date | 10/09/2024 |
| Last Update Date | 10/09/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669291308 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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