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

Revivewave Therapeutics LLC

Organization Family Nurse Practitioner · NPI 1902724776

Revivewave Therapeutics LLC is a Family Nurse Practitioner in Olive Branch, Mississippi. Registered with an NPI since 2026.

In the registry since
2026
Specialties on file
2
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

6399 Goodman Rd Ste 105
Olive Branch, MS 38654-7063
Phone: (662) 300-6822
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X
Psychiatric/Mental Health Nurse Practitioner Taxonomy 363LP0808X

Record details

NPI number1902724776
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jack Papa — Owner / Founder · (662) 300-6822
Other names Revive Integrated Wellness
NPI enumeratedJuly 8, 2026
Last updated in NPPESJuly 8, 2026
Certification dateJuly 8, 2026
Mailing address6399 Goodman Rd Ste 105, Olive Branch, MS 38654-7063

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