| 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 |
| Location | 110a S Mlk Jr Dr, Indianola, Mississippi |
| Authorized Official Name and Position | Emily Aust (CFNP/OWNER) |
| Authorized Official Contact | 6624452213 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| 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 |
| Medicare PECOS PAC ID | 9436669934 |
|---|---|
| Medicare Enrollment ID | O20250612000588 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669291308 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Emily Aust |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851624928 PECOS PAC ID: 2668668054 Enrollment ID: I20101124000609 |
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