Provider Demographics
NPI:1346947744
Name:THRIVE FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:THRIVE FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER- FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:CANNON
Authorized Official - Last Name:GODEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:337-210-5827
Mailing Address - Street 1:120 BRIGHTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7350
Mailing Address - Country:US
Mailing Address - Phone:337-356-3005
Mailing Address - Fax:
Practice Address - Street 1:1921 KALISTE SALOOM RD STE 117
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6183
Practice Address - Country:US
Practice Address - Phone:337-210-5827
Practice Address - Fax:844-482-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty