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NPI Code Detail

MEDICARE: ADVANCED HEALTH REVISION PLLC

MEDICARE: ADVANCED HEALTH REVISION PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LG0600XGerontology Nurse Practitioner

General Provider Information

NPI Number : 1235813114
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED HEALTH REVISION PLLC
Provider Business Mailing Address
First Line : 661 E MAIN ST STE 200
Second Line : BOX 118
City : MIDLOTHIAN
State : TX
Zip : 76065-3365
Country : US
Telephone Number : 972-903-4343
Fax Number : 800-782-4295
Provider Business Practice Location Address
First Line : 4201 INTERWAY PL
Second Line :
City : ARLINGTON
State : TX
Zip : 76018-5668
Country : US
Telephone Number : 972-978-2317
Fax Number : 800-782-4295
Authorized Official
Title or Position : OWNER / NURSE PRACTITIONER
Name : KIMBERLY R NEELY
Credential : NP
Telephone Number : 972-978-2317
Provider Enumeration Date : 06/12/2023
Last Update Date : 04/15/2026

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Directions to “ADVANCED HEALTH REVISION PLLC ” Practice Location

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