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General NPI Number Information
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NPI Number | 1073469870
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Entity Type | Organization
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Legal Business Name | REVIVE HEALTH AND AESTHETICS, LLC
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Dates
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Enumeration Date | 03/05/2026
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 1900 W 2ND ST STE D
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City | ELK CITY
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State | OK
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Zip | 73644-4328
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Country | US
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Telephone | 405-226-3960
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 W 2ND ST STE D
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City | ELK CITY
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State | OK
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Zip | 73644-4328
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Country | US
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Telephone | 405-226-3960
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATIE J ROBINSON
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Credential | APRN-CNP
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Telephone | 405-226-3960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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