MEDICARE: REVITALIZE HEALTH SOLUTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1811846678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVITALIZE HEALTH SOLUTIONS

Provider Business Mailing Address
First Line	:	100 SE MORELAND SCHOOL RD
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-5037
Country	:	US
Telephone Number	:	816-935-6072
Fax Number	:

Provider Business Practice Location Address
First Line	:	529 SE 2ND ST
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64063-2694
Country	:	US
Telephone Number	:	816-935-6072
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER/OWNER
Name	:	MRS. JENNIFER RUCKER
Credential	:	FNP-C
Telephone Number	:	816-935-6072

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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