ROBERT REVELL


Address: 1600 Broad Ave, Gulfport, MS 39501-3603
Phone: 2288651719

ROBERT REVELL (NPI# 1073077418) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1073077418
Entity Type Individual
Full Name ROBERT REVELL
Credential CPSS
Practice Address 1600 Broad Ave
Gulfport
MS 39501-3603
Practice Telephone 2288651719
Practice Fax Number 2288651780
Mailing Telephone 2288651719
Mailing Fax Number 2288651780
Enumeration Date 2019-01-30
Last Update Date 2019-07-12
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 175T00000X Peer Specialist 390 MS Other Service Providers

Office Location

Street Address 1600 BROAD AVE
City GULFPORT
State MS
Zip Code 39501-3603

Providers in the same location

NPI Name Taxonomy Address Enumeration
1417934175 Gulf Coast Mental Health Center Psychologist 1600 Broad Ave, Gulfport, MS 39501-3603 2005-12-23
1043811839 Kathy Ulland Counselor 1600 Broad Ave, Gulfport, MS 39501-3603 2020-11-06
1508463357 Nicole Brown Counselor 1600 Broad Ave, Gulfport, MS 39501-3603 2020-10-05
1407453376 Brian Weber Counselor 1600 Broad Ave, Gulfport, MS 39501-3603 2020-10-05
1457958639 Krysten Vagedes Registered Nurse 1600 Broad Ave, Gulfport, MS 39501-3603 2020-10-01
1184239436 Yeinil Guzman Counselor 1600 Broad Ave, Gulfport, MS 39501-3603 2020-09-14
1972117216 Nicole Hymel Counselor 1600 Broad Ave, Gulfport, MS 39501-3603 2020-09-03
1053921668 Dana Alexis Mixon Counselor 1600 Broad Ave, Gulfport, MS 39501-3603 2020-08-07
1801405964 Elizabeth Moran Peer Specialist 1600 Broad Ave, Gulfport, MS 39501-3603 2020-07-24
1013526177 June Boudreaux Peer Specialist 1600 Broad Ave, Gulfport, MS 39501-3603 2020-07-24
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1598301632 Daniel Edward Bloom Physician Assistant Naval Branch Health Clinic Gulfport, 5502 Marvin Shields Blvd, Gulfport, MS 39501 2019-11-25
1730721374 Affinity Healthcare LLC Non-emergency Medical Transport (VAN) 1822 15th St, Suite 8, Gulfport, MS 39501 2019-10-15
1093361156 Gulf Coast Companion Care, LLC Home Health 1314 Pass Road, Ste B, Gulfport, MS 39501 2019-08-14
1609420991 Greg Meekin Ent Otolaryngology 1201 31st Avenue, Gulfport, MS 39501 2019-07-25
1225681216 Murphy Chiropractic Gulfport, LLC Clinic/Center 2700 25th Ave., Gulfport, MS 39501 2019-07-19
1477022838 Patriot Healthcare of Mississippi, LLC Family Medicine 1110 Broad Street, Suite 300, Gulfport, MS 39501 2018-11-15
1477003028 Mindful Matters Nurse Practitioner 1613 23rd Avenue, Gulfport, MS 39501 2016-10-06
1902294093 Tangular Barnes Nurse Practitioner Gulf Coast Mental Health Center, 1600 Broad Ave, Gulfport, MS 39501 2014-12-25
1487065355 Huong Nguyen Pharmacist 2433 25th Avenue, Gulfport, MS 39501 2014-05-14
1770907412 Matthew Coleman Military Health Care Provider Nbhc Naval Construction Battalion Center Gulfport, 5501 Marvin Shields Blvd, Gulfport, MS 39501 2014-02-18
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Taxonomy Information

Taxonomy Code 175T00000X
Grouping Other Service Providers
Classification Peer Specialist

Taxonomy Definition

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
Notes: Source: National Uniform Claim Committee [7/1/2014: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1801405964 Elizabeth Moran Peer Specialist 1600 Broad Ave, Gulfport, MS 39501-3603 2020-07-24
1013526177 June Boudreaux Peer Specialist 1600 Broad Ave, Gulfport, MS 39501-3603 2020-07-24
1316555329 Madeline Nicklas Peer Specialist 1600 Broad Ave, Gulfport, MS 39501-3603 2020-07-15
1023660693 Jesse Gruich Peer Specialist 1600 Broad Ave, Gulfport, MS 39501-3603 2019-07-12

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1497387641 Redimere Recovery Resources LLC Peer Specialist 4646 Meadow Lake Dr, Tupelo, MS 38801-7928 2020-02-05
1770944977 Judy Dillard Peer Specialist 2100 Chambers Drive, Booneville, MS 38829 2016-03-15
1760082580 Kimberly Eve Spence Peer Specialist 152 Highway 7 S, Oxford, MS 38655-5392 2020-10-30
1508470121 Hannah Olivia Booker Peer Specialist 4905 Telephone Rd, Pascagoula, MS 39567-1823 2020-09-01
1134733967 Elizabeth Ann Shepard-bynum Peer Specialist 3407 Shamrock Ct, Gautier, MS 39553-5337 2020-08-31
1962031468 Frank Pace Peer Specialist 152 Highway 7 S, Oxford, MS 38655-5392 2020-04-06
1982230058 Hannah Jade Mixon Peer Specialist 152 Highway 7 S, Oxford, MS 38655-5392 2020-03-20
1902430887 Telena T Harmon Peer Specialist 3452 Pascagoula St Ste 3, Pascagoula, MS 39567-3203 2020-02-28
1700417110 Jennifer Nicole Zaha Peer Specialist 152 Highway 7 S, Oxford, MS 38655-5392 2020-02-04
1942847652 Suzanne Shepherd Peer Specialist 152 Highway 7 S, Oxford, MS 38655-5392 2019-12-02
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Competitor

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City GULFPORT
Zip Code 39501

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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