Organization
REVIVEWAVE THERAPEUTICS LLC
Active
Other names
Revive Integrated Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK CHANDLER PAPA MSN, APRN, FNP-C (OWNER / FOUNDER)
(662) 300-6822
Entity
Organization
Contact information
Practice address
6399 GOODMAN RD STE 105, OLIVE BRANCH, MS 38654-7063
(662) 300-6822
Mailing address
6399 GOODMAN RD STE 105, OLIVE BRANCH, MS 38654-7063
(662) 300-6822
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
07/08/2026
Last updated
07/08/2026
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