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Organization

REVIVE WELLNESS L.L.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MICHELLE CHAMBERS NP (NURSE PRACTITIONER)
(941) 626-1031
Entity
Organization

Contact information

Practice address
8302 NOTTINGHAM PKWY, LOUISVILLE, KY 40222-5540
(502) 468-5003
Mailing address
8302 NOTTINGHAM PKWY, LOUISVILLE, KY 40222-5540
(502) 468-5003

Taxonomy

Speciality
Code
Description
License number
State
2083B0002X
Obesity Medicine (Preventive Medicine) Physician
363LA2200X
Adult Health Nurse Practitioner
Primary

Other

Enumeration date
12/07/2023
Last updated
12/07/2023
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