Healthcare Provider Details

I. General information

NPI: 1053221200
Provider Name (Legal Business Name): THRIVE REVIVAL DNP NURSING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NEWBURY RD #210
THOUSAND OAKS CA
91320
US

IV. Provider business mailing address

30700 RUSSELL RANCH RD STE 250
WESTLAKE VILLAGE CA
91362-9507
US

V. Phone/Fax

Practice location:
  • Phone: 805-309-1937
  • Fax: 805-269-8951
Mailing address:
  • Phone: 805-309-1937
  • Fax: 805-269-8951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMMIE EDEN KAHL
Title or Position: CEO
Credential: FNP-BC
Phone: 805-309-1937