=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427786136
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THRIVE HEALTH & WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2022
-----------------------------------------------------
Last Update Date | 08/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 HIGHWAY 11 S STE A
-----------------------------------------------------
City | PICAYUNE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39466-4501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-795-5238
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 505
-----------------------------------------------------
City | POPLARVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39470-0505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-795-5238
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY NURSE PRACTITIONER/OWNER
-----------------------------------------------------
Name | KIMBERLY J CARVER
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 601-795-5238
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------