| Revitalist | |
|
10608 Flickenger Ln Knoxville TN 37922-3485 | |
| (865) 392-6262 | |
| Not Available |
| Full Name | Revitalist |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 10608 Flickenger Ln, Knoxville, Tennessee |
| Authorized Official Name and Position | Kathryn Walker (PRINCIPAL EMPLOYEE) |
| Authorized Official Contact | 8653926262 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revitalist 10608 Flickenger Ln Knoxville TN 37922-3485 Ph: () - | Revitalist 10608 Flickenger Ln Knoxville TN 37922-3485 Ph: (865) 392-6262 |
| NPI Number | 1073168241 |
|---|---|
| Provider Enumeration Date | 08/05/2019 |
| Last Update Date | 03/07/2025 |
| Certification Date | 03/07/2025 |
| Medicare PECOS PAC ID | 6800295650 |
|---|---|
| Medicare Enrollment ID | O20210527000088 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073168241 | NPI | - | NPPES |
| Provider Name | William A Walker |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1770551368 PECOS PAC ID: 7214831569 Enrollment ID: I20031215000130 |
| Provider Name | Kathryn A Walker |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1447671235 PECOS PAC ID: 7911139332 Enrollment ID: I20140416001973 |
| Provider Name | Claude Robinson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1144349416 PECOS PAC ID: 1951526482 Enrollment ID: I20140625002099 |
| Provider Name | Nikki Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023477601 PECOS PAC ID: 0941506174 Enrollment ID: I20160314001693 |
| Provider Name | Natalie Grace Wigle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710522636 PECOS PAC ID: 6103242029 Enrollment ID: I20200821001581 |
| Provider Name | Deborah Bush |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033520580 PECOS PAC ID: 2365660263 Enrollment ID: I20220210000668 |
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