Provider Demographics
NPI:1225785462
Name:THRIVE HEALTHCARE FNP INC
Entity Type:Organization
Organization Name:THRIVE HEALTHCARE FNP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP-C
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LAKE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:270-832-5930
Mailing Address - Street 1:1757 E CHESTNUT BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86404-8407
Mailing Address - Country:US
Mailing Address - Phone:270-832-5930
Mailing Address - Fax:
Practice Address - Street 1:1757 E CHESTNUT BLVD
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86404-8407
Practice Address - Country:US
Practice Address - Phone:270-832-5930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ080555Medicaid