Individual provider · Type 1 NPI

Ethan Revels

Student in an Organized Health Care Education/Training Program · Charleston, SC

NPI number 1578486155 Active

Practice location

15102 Sweet Pl
Charleston, SC 29492-2831

Call (704) 689-3747 Map

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant 363A00000XNone listed
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1578486155

Ethan Revels's National Provider Identifier is 1578486155, issued on Jul 31, 2026. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Charleston, SC. The record was last updated on Jul 31, 2026.