Healthcare Provider Details

I. General information

NPI: 1427989565
Provider Name (Legal Business Name): REVOLUTION ACCESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6541 MERIDIEN DR STE 113
RALEIGH NC
27616-3211
US

IV. Provider business mailing address

9495 WINNETKA AVE N STE 200
BROOKLYN PARK MN
55445-1706
US

V. Phone/Fax

Practice location:
  • Phone: 984-375-8600
  • Fax: 866-554-5275
Mailing address:
  • Phone: 763-255-3800
  • Fax: 763-255-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KILEY ANN RUSSELL
Title or Position: SENIOR DIRECTOR
Credential:
Phone: 629-252-8211