REVIVE PRIMARY CARE AND MEDSPA PLLC
NPI 1457203879
Nurse Practitioner - Gerontology in La Follette, TN

Q: What is Revive Primary Care And Medspa PLLC's NPI number?

The NPI number for Revive Primary Care And Medspa PLLC is 1457203879. It was assigned to this organization in the NPPES registry on February 10, 2026.

Q: What is Revive Primary Care And Medspa PLLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.

Active since February 10, 2026

2221 JACKSBORO PIKE STE A18, LA FOLLETTE, TN 37766(937) 408-7606(865) 332-1923 Get Directions Write a Review

NPPES record last updated: February 10, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Revive Primary Care And Medspa Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

REVIVE PRIMARY CARE AND MEDSPA PLLC (NPI 1457203879) is a healthcare organization registered as a gerontology in La Follette, Tennessee and active in the NPI registry since February 2026. The organization lists Heidi M Marlow, Agnp-cb, as its authorized official.

NPPES Registry Identity

NPI1457203879

Entity TypeOrganization

Primary Taxonomy363LG0600X

Legal Business NameREVIVE PRIMARY CARE AND MEDSPA PLLC

Location Address2221 JACKSBORO PIKE STE A18La Follette, TN 37766-3035

Mailing Address2221 Jacksboro Pike Ste A18La Follette, TN 37766-3035 · (937) 408-7606 · Fax (865) 332-1923

Phone(937) 408-7606

Fax(865) 332-1923

Organization SubpartNo

Authorized OfficialHeidi M MarlowAgnp-cb · (937) 408-7606

Enumeration DateFebruary 10, 2026

NPPES CertifiedFebruary 10, 2026

✔ NPI 1457203879 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · GerontologyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LG0600X

2221 JACKSBORO PIKE STE A18, La Follette, TN 37766

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HEIDI M MARLOW AGNP-CB

Nurse Practitioner (Gerontology)

2221 JACKSBORO PIKE STE A18
LA FOLLETTE, TN 37766

Campbell County (865) 333-4770

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Revive Primary Care And Medspa PLLC's NPI number?

The NPI number for Revive Primary Care And Medspa PLLC is 1457203879. It was assigned to this organization in the NPPES registry on February 10, 2026.

Where is Revive Primary Care And Medspa PLLC located?

Revive Primary Care And Medspa PLLC is located at 2221 Jacksboro Pike Ste A18, La Follette, TN 37766. The listed phone number is (937) 408-7606.

What is Revive Primary Care And Medspa PLLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.

When was this NPI record last updated?

The NPPES record for Revive Primary Care And Medspa PLLC was last updated on February 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.