| NPI | 1902724776 |
|---|---|
| Doing Business As | REVIVE INTEGRATED WELLNESS |
| Entity Type | Organization |
| Authorized Contact | JACK CHANDLER PAPA Owner / Founder 662-300-6822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2026-07-08 |
| Last Update Date | 2026-07-08 |