Healthcare Provider Details

I. General information

NPI: 1366374167
Provider Name (Legal Business Name): THRIVE INTEGRATIVE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4712 BOCA LN
LEXINGTON KY
40515-6463
US

IV. Provider business mailing address

4712 BOCA LN
LEXINGTON KY
40515-6463
US

V. Phone/Fax

Practice location:
  • Phone: 502-276-5465
  • Fax: 502-371-8293
Mailing address:
  • Phone: 502-276-5465
  • Fax: 502-371-8293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER DIANE GORDON
Title or Position: OWNER
Credential: FNP
Phone: 502-276-5465