Individual
MRS. TISA MARIE REVELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SA-C, KCSA
Contact information
Practice address
4001 KRESGE WAY, SUITE 200, LOUISVILLE, KY 40207-4640
(502) 895-1995
(502) 895-6479
Mailing address
PO BOX 950248, LOUISVILLE, KY 40295-0248
(502) 253-1035
(502) 253-1037
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
SA029
KY
246ZC0007X
Surgical Assistant
Primary
SA029
KY
Other
Enumeration date
02/15/2007
Last updated
03/03/2016
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