Healthcare Provider Details

I. General information

NPI: 1811721020
Provider Name (Legal Business Name): REVIVE PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 ALEXANDER ST
MEMPHIS TN
38111-4451
US

IV. Provider business mailing address

1910 MADISON AVE # 2628
MEMPHIS TN
38104-2620
US

V. Phone/Fax

Practice location:
  • Phone: 901-352-8994
  • Fax: 440-291-8182
Mailing address:
  • Phone: 901-352-8994
  • Fax: 440-294-8182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: KENDRA POWERS
Title or Position: OWNER, DNP, APRN, PMHNP-BC
Credential: DNP, APRN, PMHNP-BC
Phone: 901-352-8994