Provider Demographics
NPI:1174411102
Name:REVOLUTION WELLNESS
Entity type:Organization
Organization Name:REVOLUTION WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:225-931-5699
Mailing Address - Street 1:37283 SWAMP RD STE 1102
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3232
Mailing Address - Country:US
Mailing Address - Phone:225-931-5699
Mailing Address - Fax:
Practice Address - Street 1:37283 SWAMP RD STE 1102
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3232
Practice Address - Country:US
Practice Address - Phone:225-931-5699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty