# REVOLUTION HEALTH & WELLNESS CLINIC PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649515446
- **Authorized official:** DR. CHAD PRESTON EDWARDS D.O. (PHYSICIAN/OWNER)
- **Authorized official phone:** (918) 935-3636

## Contact information

- **Practice address:** 12142 S YUKON AVE, GLENPOOL, OK 74033-6621
- **Practice address phone:** (918) 935-3636
- **Practice address fax:** (918) 935-3635
- **Mailing address:** 2865 E SKELLY DR STE 300, TULSA, OK 74105-6233
- **Mailing address phone:** (918) 935-3636
- **Mailing address fax:** (918) 935-3635

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 4353 | OK | Yes |

## Other

- **Enumeration date:** 12/05/2012
- **Last updated:** 02/22/2021