MEDICARE: THRIVE NEUROHEALTH, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1740075720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE NEUROHEALTH, LLC.

Provider Business Mailing Address
First Line	:	48 ROBB RD
Second Line	:
City	:	SPRINGFIELD
State	:	AR
Zip	:	72157-9611
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3905 BROOKEN HILL DR
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-9282
Country	:	US
Telephone Number	:	479-747-2792
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTOPHER TITSWORTH
Credential	:	APRN
Telephone Number	:	479-747-2792

Provider Enumeration Date	:	04/11/2025
Last Update Date	:	04/11/2025

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