Provider Demographics
NPI:1467164095
Name:VIVE INFUSION AND WELLNESS
Entity Type:Organization
Organization Name:VIVE INFUSION AND WELLNESS
Other - Org Name:VIVE INFUSION AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:870-336-1216
Mailing Address - Street 1:3410 E JOHNSON AVE STE Z
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-1876
Mailing Address - Country:US
Mailing Address - Phone:870-336-1216
Mailing Address - Fax:870-336-1215
Practice Address - Street 1:3410 E JOHNSON AVE STE Z
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72405-1876
Practice Address - Country:US
Practice Address - Phone:870-336-1216
Practice Address - Fax:870-336-1215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy