Healthcare Provider Details

I. General information

NPI: 1912814591
Provider Name (Legal Business Name): THRIVE ADULT AND SENIOR PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8517 KINGSTON ST
AVON IN
46123-6018
US

IV. Provider business mailing address

8517 KINGSTON ST
AVON IN
46123-6018
US

V. Phone/Fax

Practice location:
  • Phone: 317-772-9145
  • Fax:
Mailing address:
  • Phone: 317-772-9145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BUKOLA F SHOLABI
Title or Position: OWNER/MANAGING MEMBER
Credential: AGNP-PC
Phone: 317-772-9145