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

Revive Wellness and Aesthetics

Organization Family Nurse Practitioner · NPI 1548940752

Revive Wellness and Aesthetics is a Family Nurse Practitioner in Eagle, Idaho. Registered with an NPI since 2023.

In the registry since
2023

Practice location Address checks out

445 S Fitness Pl # 130
Eagle, ID 83616-6828
Phone: (208) 939-2332
Show map & directions

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

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X

Record details

NPI number1548940752
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kelsey Martin — Owner/Nurse Practitioner · (217) 617-2575
NPI enumeratedJuly 21, 2023
Last updated in NPPESJuly 21, 2023
Certification dateJuly 21, 2023
Mailing address4253 N Sorrel Pl, Boise, ID 83703-3487

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