Healthcare Provider Details

I. General information

NPI: 1508793282
Provider Name (Legal Business Name): THRIVE PSYCHIATRIC WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W IRONWOOD DR STE B
COEUR D ALENE ID
83814-2604
US

IV. Provider business mailing address

PO BOX 46
SANDPOINT ID
83864-0046
US

V. Phone/Fax

Practice location:
  • Phone: 208-664-1594
  • Fax:
Mailing address:
  • Phone: 970-457-7973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROBERT KYLE WEAVER
Title or Position: PMHNP
Credential: APRN-CNP
Phone: 208-664-1594