# REVIVE HEALTHCARE CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Revive Healthcare Clinic LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174349104
- **Authorized official:** CHEKWUBE MARTHA OKOLI (OWNER)
- **Authorized official phone:** (469) 567-9974

## Contact information

- **Practice address:** 1221 WEST AIRPORT FWY STE\# 209 UNIT B, IRVING, TX 75062
- **Practice address phone:** (214) 777-2703
- **Practice address fax:** (817) 865-1530
- **Mailing address:** 1221 WEST AIRPORT FWY STE\# 209 UNIT B, IRVING, TX 75062
- **Mailing address phone:** (214) 777-2703
- **Mailing address fax:** (817) 865-1530

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/25/2024
- **Last updated:** 03/18/2025