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General NPI Number Information
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NPI Number | 1831003250
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Entity Type | Organization
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Legal Business Name | REVIVE HYDRATION PLLC
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 505 S MAIN ST
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City | RED BUD
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State | IL
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Zip | 62278-1212
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Country | US
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Telephone | 618-408-1248
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Fax |
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Provider Business Mailing Address
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Address Line | 4740 KANE HILL RD
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City | ELLIS GROVE
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State | IL
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Zip | 62241-1728
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Country | US
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Telephone | 618-408-1248
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Fax |
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Authorized Official
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Title or Position | OWNER / MEMBER
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Name | JENNIFER KNOTT
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Credential | APRN, PMHNP-BC
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Telephone | 618-615-8898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State | NULL
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