Healthcare Provider Details

I. General information

NPI: 1912832932
Provider Name (Legal Business Name): REVIVE WELLNESS AND AESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 TATE BLVD SE
HICKORY NC
28602-1430
US

IV. Provider business mailing address

4020 PLEASANT GROVE CHURCH RD
SHELBY NC
28150-2842
US

V. Phone/Fax

Practice location:
  • Phone: 828-457-8987
  • Fax: 828-571-5613
Mailing address:
  • Phone: 828-457-8987
  • Fax: 828-571-5613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: SARA PIERCY
Title or Position: OWNER, NURSE PRACTITIONER
Credential: NP
Phone: 828-457-8987