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General NPI Number Information
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NPI Number | 1912814591
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Entity Type | Organization
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Legal Business Name | THRIVE ADULT AND SENIOR PRIMARY CARE
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Dates
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Enumeration Date | 08/27/2026
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Last Update Date | 08/27/2026
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Provider Practice Location Address
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Address Line | 8517 KINGSTON ST
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City | AVON
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State | IN
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Zip | 46123-6018
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Country | US
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Telephone | 317-772-9145
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Fax |
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Provider Business Mailing Address
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Address Line | 8517 KINGSTON ST
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City | AVON
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State | IN
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Zip | 46123-6018
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Country | US
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Telephone | 317-772-9145
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGING MEMBER
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Name | BUKOLA F SHOLABI
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Credential | AGNP-PC
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Telephone | 317-772-9145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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