Healthcare Provider Details

I. General information

NPI: 1346799574
Provider Name (Legal Business Name): HANNAH REVELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 KEITH DR
PERRY GA
31069-2947
US

IV. Provider business mailing address

1040 KEITH DR
PERRY GA
31069-2947
US

V. Phone/Fax

Practice location:
  • Phone: 478-988-1515
  • Fax: 478-313-4015
Mailing address:
  • Phone: 479-988-1515
  • Fax: 478-313-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN231047
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: