# REVITALIZE HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821910803
- **Authorized official:** HEATHER KING FNP (CEO)
- **Authorized official phone:** (208) 763-8920

## Contact information

- **Practice address:** 250 NORTHWEST BLVD STE 200, COEUR D ALENE, ID 83814-2973
- **Practice address phone:** (208) 763-8920
- **Practice address fax:** (208) 203-0947
- **Mailing address:** 4204 N MOCCASIN RD, COEUR D ALENE, ID 83815-8826
- **Mailing address phone:** (208) 763-8920
- **Mailing address fax:** (208) 763-8920

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 07/29/2026
- **Last updated:** 07/29/2026