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General NPI Number Information
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NPI Number | 1619840899
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Entity Type | Organization
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Legal Business Name | FLOURISHINGTON LLC
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Dates
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Enumeration Date | 09/24/2025
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 7304 COMBINE DR
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City | LAFAYETTE
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State | IN
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Zip | 47905-9542
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Country | US
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Telephone | 765-209-8193
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Fax |
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Provider Business Mailing Address
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Address Line | 7304 COMBINE DR
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City | LAFAYETTE
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State | IN
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Zip | 47905-9542
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Country | US
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Telephone | 765-209-8193
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. DAVID OLATUNBOSUN FOWOPE
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Credential | PMHNP-BC
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Telephone | 765-209-8193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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