Healthcare Provider Details

I. General information

NPI: 1063195808
Provider Name (Legal Business Name): THRIVE PEDIATRIC NURSING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7197 SHERIDAN RD STE 105
WHITE HALL AR
71602-3261
US

IV. Provider business mailing address

7197 SHERIDAN RD STE 105
WHITE HALL AR
71602-3261
US

V. Phone/Fax

Practice location:
  • Phone: 870-329-8252
  • Fax:
Mailing address:
  • Phone: 870-329-8252
  • Fax: 888-901-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE M MANTUANO
Title or Position: PRESIDENT
Credential:
Phone: 870-247-6131