Provider Demographics
NPI:1225913916
Name:REVITALIZED HEALTH PLLC
Entity type:Organization
Organization Name:REVITALIZED HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOLIVETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-202-0995
Mailing Address - Street 1:516 EARLE AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41015-1611
Mailing Address - Country:US
Mailing Address - Phone:740-202-0995
Mailing Address - Fax:
Practice Address - Street 1:516 EARLE AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41015-1611
Practice Address - Country:US
Practice Address - Phone:740-202-0995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine