Healthcare Provider Details

I. General information

NPI: 1841213238
Provider Name (Legal Business Name): APRIL REVIS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9755 WEST STATE HWY 22
RATCLIFF AR
72951
US

IV. Provider business mailing address

P.O. BOX 130
RATCLIFF AR
72951
US

V. Phone/Fax

Practice location:
  • Phone: 479-635-5300
  • Fax: 479-635-2010
Mailing address:
  • Phone: 479-635-5300
  • Fax: 479-635-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA01858
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: