Organization
REVITALIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHRYN WALKER CRNA (PRINCIPAL EMPLOYEE)
(865) 392-6262
Entity
Organization
Contact information
Practice address
10608 FLICKENGER LN, KNOXVILLE, TN 37922-3485
(865) 392-6262
Mailing address
10608 FLICKENGER LN, KNOXVILLE, TN 37922-3485
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QI0500X
Infusion Therapy Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
08/05/2019
Last updated
03/07/2025
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