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General NPI Number Information
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NPI Number | 1811846678
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Entity Type | Organization
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Legal Business Name | REVITALIZE HEALTH SOLUTIONS
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Dates
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Enumeration Date | 01/26/2026
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 529 SE 2ND ST
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City | LEES SUMMIT
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State | MO
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Zip | 64063-2694
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Country | US
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Telephone | 816-935-6072
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Fax |
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Provider Business Mailing Address
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Address Line | 100 SE MORELAND SCHOOL RD
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City | BLUE SPRINGS
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State | MO
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Zip | 64014-5037
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Country | US
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Telephone | 816-935-6072
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | MRS. JENNIFER RUCKER
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Credential | FNP-C
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Telephone | 816-935-6072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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