Revival Wellness & Ketamine
Revival Wellness & Ketamine is a healthcare organization registered as Mental Health Clinic/Center (Including Community Mental Health Center) in Chantilly, VA, holding Type 2 (organization) NPI 1093514655 since 2025. The authorized official on file is Nicole Watson, Founder.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1093514655 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Revival Wellness & Ketamine |
| Practice address | 4200B TECHNOLOGY CT, Chantilly, VA, 20151 |
| Phone | 7039883984 |
| Enumeration date | 2025-03-07 |
| Last updated in NPPES | 2025-11-03 |
Authorized official
| Name | Nicole Watson |
|---|---|
| Title | Founder |
| Phone | 7039883984 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | Primary | — | — |
Copy-ready billing details
Provider: Revival Wellness & Ketamine NPI: 1093514655 Taxonomy: 261QM0801X (Mental Health Clinic/Center (Including Community Mental Health Center)) Address: 4200B TECHNOLOGY CT, Chantilly, VA, 20151
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1588941207 | Emily Derocco | Individual | Pediatric Chiropractor | Chantilly, VA |
| 1063841971 | Nicole Watson | Individual | Psychiatric/Mental Health Nurse Practitioner | Chantilly, VA |
| 1023622438 | Virtual Physio, LLC | Organization | Physical Therapist | Chantilly, VA |
| 1700564549 | Sarah Gilpatrick | Individual | Family Nurse Practitioner | Chantilly, VA |
| 1275318651 | Summit Health Pllc | Organization | Primary Care Clinic/Center | Chantilly, VA |
| 1295604726 | Madeline Segall | Individual | Chiropractor | Chantilly, VA |
Verify this record
Cross-check NPI 1093514655 against the authoritative CMS record: view Revival Wellness & Ketamine on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What type of organization is Revival Wellness & Ketamine?
What is a Type 2 NPI?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2025-11-03.