OrganizationActive
Revive Wellness and Aesthetics
NPI 1548940752 · Family Nurse Practitioner · Eagle, ID
Provider details
- NPI number
- 1548940752
- Entity type
- Organization
- Primary specialty
- Family Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Kelsey Martin, Owner/Nurse Practitioner(217) 617-2575
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
Established profile(58/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
2 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
445 S Fitness Pl # 130
Eagle, ID 83616-6828
Phone: (208) 939-2332
Street-level locationGet directions
Mailing address
4253 N Sorrel Pl
Boise, ID 83703-3487
Registry dates
- Enumerated
- 2023-07-21
- Last updated
- 2023-07-21
- Certified
- 2023-07-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.