Healthcare Provider Details

I. General information

NPI: 1114864113
Provider Name (Legal Business Name): THRIVE PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2436 HIDEAWAY PL
JACKSON MS
39211-6740
US

IV. Provider business mailing address

2436 HIDEAWAY PL
JACKSON MS
39211-6740
US

V. Phone/Fax

Practice location:
  • Phone: 601-573-9584
  • Fax:
Mailing address:
  • Phone: 601-573-9584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JANAE WHITE
Title or Position: NURSE PRACTITIONER
Credential: FNP-C
Phone: 601-573-9584