Revive Health Spa LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

REVIVE HEALTH SPA LLC

Practice address

107 N Main Ave
Bolivar, MO 65613-1517

Phone

(417) 680-7060

Fax

(800) 828-7117

NPI assigned

Jul 10, 2026

Organization subpart

No

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

Authorized official

Name

Shelby Bailey, NPNPI 1730600974

Title

Owner

Phone

(417) 298-6908

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shelby Jo Bailey, FNP-C

  • Family Nurse Practitioner
  • Nashville, TN
  • NPI 1730600974
  NPD (past) Authorized official

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

{
    "created_epoch": "1783641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783641600000",
    "number": "1487573879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 N MAIN AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656131517",
            "telephone_number": "417-680-7060",
            "fax_number": "800-828-7117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 N MAIN AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656131517",
            "telephone_number": "417-680-7060",
            "fax_number": "800-828-7117"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "871 US Highway 60 E",
            "address_purpose": "LOCATION",
            "city": "Republic",
            "state": "MO",
            "postal_code": "657381572",
            "country_code": "US",
            "telephone_number": "417-298-6908",
            "fax_number": "800-828-7117",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REVIVE HEALTH SPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-07-10",
        "last_updated": "2026-07-10",
        "certification_date": "2026-07-11",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "SHELBY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-298-6908",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zach Reasoner
• Richard G. Reber, M.D.
• Lanie Rae Redd
• Regional Foot and Ankle, LLC
• Renal Care Group of the Ozarks, LLC (Renal Care Group Bolivar)
• Revive Medical LLC
• Haris Riaz, M.D.
• Michelle K Rieck, NHA CPH
• Joyce Dianne Ries, LCSW
• Kelly Rinker, SLP

• Clinic/Center in Bolivar, MO
• Providers in Bolivar, MO by specialty
• Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.