MEDICARE: AMBER ELIZABETH SPIVEY REVILLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN-NP296393	GA

General Provider Information

NPI Number	:	1518705300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER ELIZABETH SPIVEY REVILLE

Provider Business Mailing Address
First Line	:	PO BOX 26485
Second Line	:	DEPT 1138
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-9084
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3235 DEANS BRIDGE RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30906-7004
Country	:	US
Telephone Number	:	731-394-1145
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2024
Last Update Date	:	01/05/2026

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