MEDICARE: HEALTH AND REJUVENATE SPA AND CLINIC, LLC

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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1972466795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH AND REJUVENATE SPA AND CLINIC, LLC

Provider Business Mailing Address
First Line	:	340 SIBLEY RD
Second Line	:
City	:	CHOUDRANT
State	:	LA
Zip	:	71227-3914
Country	:	US
Telephone Number	:	318-355-2435
Fax Number	:	866-728-6481

Provider Business Practice Location Address
First Line	:	104 NORTHPARK DRIVE
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201
Country	:	US
Telephone Number	:	318-355-2435
Fax Number	:	866-728-6481

Authorized Official
Title or Position	:	OWNER
Name	:	MELISSA FUTRELL
Credential	:	NP
Telephone Number	:	318-355-2435

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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