Organization
REVIVE WELLNESS AND AESTHETICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMILY AUST APRN (CFNP/OWNER)
(662) 445-2213
Entity
Organization
Contact information
Practice address
110A S MLK JR DR, INDIANOLA, MS 38751-2622
(662) 445-2213
(662) 445-2214
Mailing address
110A S MLK JR DR, INDIANOLA, MS 38751-2622
(662) 445-2213
(662) 445-2214
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
10/09/2024
Last updated
10/09/2024
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