Organization · Type 2 NPI

Revive Healthcare Clinic LLC

Primary Care Nurse Practitioner · Irving, TX

NPI number 1174349104 Active

Practice location

1221 West Airport Fwy STE# 209 Unit B
Irving, TX 75062

Fax (817) 865-1530

Specialties and licenses

Taxonomy	Code	License
Primary Care Nurse Practitioner Primary	363LP2300X	None listed

Primary Care Nurse Practitioner: Definition to come...

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NPI record

NPI: 1174349104
Entity type: Organization (Type 2)
Issued: Nov 25, 2024
Last updated: Mar 18, 2025
Status: Active

Other names

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Revive Healthcare Clinic LLC · former legal business name
Revive Healthcare Clinic LLC · former legal business name

Authorized official

Chekwube Martha Okoli
Owner
(469) 567-9974

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1174349104

Revive Healthcare Clinic LLC's National Provider Identifier is 1174349104, issued on Nov 25, 2024. The primary taxonomy on file is Primary Care Nurse Practitioner (363LP2300X), and the practice location is in Irving, TX. The record was last updated on Mar 18, 2025.