Organization
REVITALIZE IV HYDRATION AND WELLNESS CLINC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FELICA JOHNSON NURSE PRACTITIONER (FNP)
(870) 273-4164
Entity
Organization
Contact information
Practice address
2704 PHILLIPS DR STE A, JONESBORO, AR 72401-7399
(870) 955-5701
(302) 209-5619
Mailing address
2704 PHILLIPS DR STE A, JONESBORO, AR 72401-7399
(870) 955-5701
(302) 209-5619
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/28/2023
Last updated
12/04/2023
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