Organization
REVIVE & REMEDY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRI TRICHEL WALLACE-BASKEN FNP (OWNER)
(901) 335-8541
Entity
Organization
Contact information
Practice address
2851 SHELBY ST, BARTLETT, TN 38134-4509
(901) 335-8541
(901) 425-9685
Mailing address
2851 SHELBY ST, BARTLETT, TN 38134-4509
(901) 842-1480
(901) 425-9685
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
—
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
08/25/2021
Last updated
02/02/2022
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