Revitalize Health and Wellness LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

REVITALIZE HEALTH AND WELLNESS LLC

Practice address

16339 Silver Spring Dr
Choctaw, OK 73020-5807

Phone

(918) 633-0622

NPI assigned

Apr 7, 2025

Last updated

Sep 5, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bethany BiaNPI 1770075764

Title

Part Owner

Phone

(918) 633-0622

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bethany S Bia, APRN-FNP

  • Primary Care Nurse Practitioner
  • Checotah, OK
  • NPI 1770075764
  Medicare reassignment Care Compare group NPD Authorized official
• Sarah Emily Jones, APRN

  • Family Nurse Practitioner
  • Midwest City, OK
  • NPI 1629739891
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1743984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757030400000",
    "number": "1255125019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16339 SILVER SPRING DR",
            "city": "CHOCTAW",
            "state": "OK",
            "postal_code": "730205807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16339 SILVER SPRING DR",
            "city": "CHOCTAW",
            "state": "OK",
            "postal_code": "730205807",
            "telephone_number": "918-633-0622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE HEALTH AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-07",
        "last_updated": "2025-09-05",
        "certification_date": "2025-09-05",
        "status": "A",
        "authorized_official_last_name": "BIA",
        "authorized_official_first_name": "BETHANY",
        "authorized_official_title_or_position": "PART OWNER",
        "authorized_official_telephone_number": "918-633-0622"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207QS1201X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sleep Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629739891",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17770075764",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Todd J Ramer, CNS
• Janice Kay Ray, MS, CCC-SLP/L
• Tammy Rea
• Kasadi Shandale Reimers
• Resolve Wound Care LLC
• Amber Marie Reyes
• Julie Lynn Rials, NP
• Deandria Elaine Rideau, PSYCHOTHERAPIST
• Darek Kevin Ridpath, D.D.S.
• Tamara Suzanne Roberson, ED.D

• Nurse Practitioner in Choctaw, OK
• Providers in Choctaw, OK by specialty
• Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.