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General NPI Number Information
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NPI Number | 1760066633
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Entity Type | Organization
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Legal Business Name | THRIVE PSYCHIATRIC & MEDICATION LLC
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Dates
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Enumeration Date | 05/07/2021
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 1220 N MAIN ST
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City | NEWCASTLE
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State | OK
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Zip | 73065-4175
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Country | US
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Telephone | 405-703-9942
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 N MAIN ST STE 4
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City | NEWCASTLE
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State | OK
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Zip | 73065-4175
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Country | US
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Telephone | 405-703-9942
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TANYA MARIE RENNIE
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Credential | APRN
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Telephone | 405-703-9942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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