Healthcare Provider Details

I. General information

NPI: 1982556502
Provider Name (Legal Business Name): REVIVE AND THRIVE INTEGRATIVE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2026
Last Update Date: 02/14/2026
Certification Date: 02/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14074 PASCO MONTRA RD
ANNA OH
45302-9708
US

IV. Provider business mailing address

14074 PASCO MONTRA RD
ANNA OH
45302-9708
US

V. Phone/Fax

Practice location:
  • Phone: 937-646-5026
  • Fax: 888-222-6607
Mailing address:
  • Phone: 937-646-5026
  • Fax: 888-222-6607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. CINDY FLEMING
Title or Position: OWNER
Credential: CNP
Phone: 937-646-5026