Healthcare Provider Details

I. General information

NPI: 1467164095
Provider Name (Legal Business Name): VIVE INFUSION AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 02/17/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 E JOHNSON AVE STE Z
JONESBORO AR
72405-1876
US

IV. Provider business mailing address

3410 E JOHNSON AVE STE Z
JONESBORO AR
72405-1876
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-1216
  • Fax: 870-336-1215
Mailing address:
  • Phone: 870-336-1216
  • Fax: 870-336-1215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARRIE TATE
Title or Position: OWNER
Credential: PMHNP
Phone: 870-336-1216