Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Revive Primary Care and Medspa PLLC

Organization Gerontology Nurse Practitioner · NPI 1457203879

Revive Primary Care and Medspa PLLC is a Gerontology Nurse Practitioner in LA Follette, Tennessee. Registered with an NPI since 2026.

In the registry since
2026
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

2221 Jacksboro Pike Ste A18
LA Follette, TN 37766-3035
Phone: (937) 408-7606
Fax: (865) 332-1923
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Gerontology Nurse Practitioner (primary) Taxonomy 363LG0600X

Record details

NPI number1457203879
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Heidi Marlow — Agnp-Cb · (937) 408-7606
NPI enumeratedFebruary 10, 2026
Last updated in NPPESFebruary 10, 2026
Certification dateFebruary 10, 2026
Mailing address2221 Jacksboro Pike Ste A18, La Follette, TN 37766-3035

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