Provider Demographics
NPI:1841213238
Name:REVIS, APRIL (APN)
Entity Type:Individual
Prefix:MRS
First Name:APRIL
Middle Name:
Last Name:REVIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 130
Mailing Address - Street 2:
Mailing Address - City:RATCLIFF
Mailing Address - State:AR
Mailing Address - Zip Code:72951
Mailing Address - Country:US
Mailing Address - Phone:479-635-5300
Mailing Address - Fax:479-635-2010
Practice Address - Street 1:9755 WEST STATE HWY 22
Practice Address - Street 2:
Practice Address - City:RATCLIFF
Practice Address - State:AR
Practice Address - Zip Code:72951
Practice Address - Country:US
Practice Address - Phone:479-635-5300
Practice Address - Fax:479-635-2010
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01858363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR156465758Medicaid
AR5Y352OtherAR BCBS
AR156465758Medicaid
AR5Y352OtherAR BCBS