Organization
REVAN HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN EVANS (CEO)
(405) 896-7975
Entity
Organization
Contact information
Practice address
5601 NW 72ND ST STE 142, WARR ACRES, OK 73132-5924
(405) 896-7975
(866) 473-0490
Mailing address
5601 NW 72ND ST STE 242, WARR ACRES, OK 73132-5923
(405) 896-7975
(866) 473-0490
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200917850A
—
OK
Enumeration date
05/19/2020
Last updated
02/03/2021
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