Provider Demographics
NPI:1972182350
Name:FLOURISH INTEGRATIVE WELLNESS LLC
Entity Type:Organization
Organization Name:FLOURISH INTEGRATIVE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:417-812-8800
Mailing Address - Street 1:133 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:AVA
Mailing Address - State:MO
Mailing Address - Zip Code:65608-5530
Mailing Address - Country:US
Mailing Address - Phone:417-812-8800
Mailing Address - Fax:
Practice Address - Street 1:133 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:AVA
Practice Address - State:MO
Practice Address - Zip Code:65608-5530
Practice Address - Country:US
Practice Address - Phone:417-812-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care