Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mrs. Tisa Marie Revels, SA-C, KCSA

Individual provider Specialist · NPI 1750424859

Mrs. Tisa Marie Revels, SA-C, KCSA is a Specialist in Louisville, Kentucky. Practices as a sole proprietor. Licensed in Kentucky.

Licensed in
KY
In the registry since
2007
Specialties on file
2
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Practice location Address checks out

4001 Kresge Way Ste 200
Louisville, KY 40207-4640
Phone: (502) 895-1995
Fax: (502) 895-6479
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Assistant (primary) Taxonomy 246ZC0007X · Licence SA029 (KY)
Specialist Taxonomy 174400000X · Licence SA029 (KY)

Record details

NPI number1750424859
Entity typeIndividual (Type 1)
GenderFemale
Credentials SA-C , KCSA
Sole proprietorYes
NPI enumeratedFebruary 15, 2007
Last updated in NPPESMarch 3, 2016

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