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REVIVE WELLNESS AND AESTHETICS LLC
NPI 1669291308
Clinic/Center - Primary Care in Indianola, MS

Active since October 09, 2024CLIA 25D2326779 · Waiver
110A S MLK JR DR, INDIANOLA, MS 38751(662) 445-2213(662) 445-2214 Get Directions Write a Review

NPPES record last updated: October 9, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Revive Wellness And Aesthetics Llc NPPES

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

REVIVE WELLNESS AND AESTHETICS LLC (NPI 1669291308) is a healthcare organization registered as a primary care in Indianola, Mississippi and active in the NPI registry since October 2024. The organization holds a CLIA Waiver certificate valid through July 8, 2027 and lists Emily Aust, Cfnp/owner, as its authorized official.

NPPES Registry Identity

NPI1669291308
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameREVIVE WELLNESS AND AESTHETICS LLC
Location Address110A S MLK JR DRIndianola, MS 38751-2622
Mailing Address110a S Mlk Jr DrIndianola, MS 38751-2622 · (662) 445-2213 · Fax (662) 445-2214
Phone(662) 445-2213
Fax(662) 445-2214
Organization SubpartNo
Authorized OfficialEmily AustCfnp/owner · (662) 445-2213
Enumeration DateOctober 9, 2024
NPPES CertifiedOctober 9, 2024
✔ NPI 1669291308 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
110A S MLK JR DR, Indianola, MS 38751
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 25D2326779

Revive Wellness And Aesthetics · Indianola, MS
Active · expires Jul 8, 2027
CLIA Number25D2326779
Laboratory TypePhysician Office
Certificate Effective DateJuly 9, 2025
Certificate Expiration DateJuly 8, 2027
Laboratory DirectorEmily Aust
Laboratory Phone(662) 445-2213
Laboratory LocationRevive Wellness And Aesthetics110A South Mlk Jr Blvd, Indianola, MS 38751
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Wellness And Aesthetics LLC's NPI number?

The NPI number for Revive Wellness And Aesthetics LLC is 1669291308. It was assigned to this organization in the NPPES registry on October 9, 2024.

Where is Revive Wellness And Aesthetics LLC located?

Revive Wellness And Aesthetics LLC is located at 110A S Mlk Jr Dr, Indianola, MS 38751. The listed phone number is (662) 445-2213.

What is Revive Wellness And Aesthetics LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Revive Wellness And Aesthetics LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D2326779) is associated with this NPI, valid through July 8, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Revive Wellness And Aesthetics LLC was last updated on October 9, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 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.