=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992616783
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IVY SKIN STUDIO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2026
-----------------------------------------------------
Last Update Date | 09/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 LIBERTY PIKE STE 1000
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37067-8636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-471-8525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 LIBERTY PIKE STE 1000
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37067-8636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-471-8525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER/OWNER
-----------------------------------------------------
Name | IVY PROTHRO
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 305-302-1514
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------