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FOURTH WALL WELLNESS LLC
NPI 1124869581
Nurse Practitioner - Psychiatric/Mental Health in Tucson, AZ

Active since June 01, 2024
6137 E GRANT RD, TUCSON, AZ 85712(520) 436-3922 Get Directions Write a Review

NPPES record last updated: February 24, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Fourth Wall Wellness Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FOURTH WALL WELLNESS LLC (NPI 1124869581) is a healthcare organization registered as a psychiatric/mental health in Tucson, Arizona and active in the NPI registry since June 2024. The organization lists Aurora Thrush, Member, as its authorized official.

NPPES Registry Identity

NPI1124869581
Entity TypeOrganization
Primary Taxonomy363LP0808X
Legal Business NameFOURTH WALL WELLNESS LLC
Location Address6137 E GRANT RDTucson, AZ 85712-5829
Mailing Address6137 E Grant RdTucson, AZ 85712-5829 · (520) 436-3922
Phone(520) 436-3922
Organization SubpartNo
Authorized OfficialAurora ThrushMember · (720) 232-7784
Enumeration DateJune 1, 2024
Last NPPES UpdateFebruary 24, 2025
NPPES CertifiedFebruary 24, 2025
✔ NPI 1124869581 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X
6137 E GRANT RD, Tucson, AZ 85712
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ADA GINGYEN LAM
Counselor (Mental Health)
6137 E GRANT RD
TUCSON, AZ 85712
Pima County (520) 436-3922
SARA MOSS
Nurse Practitioner (Psychiatric/Mental Health)
6137 E GRANT RD
TUCSON, AZ 85712
Pima County (520) 258-1739

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fourth Wall Wellness LLC's NPI number?

The NPI number for Fourth Wall Wellness LLC is 1124869581. It was assigned to this organization in the NPPES registry on June 1, 2024.

Where is Fourth Wall Wellness LLC located?

Fourth Wall Wellness LLC is located at 6137 E Grant Rd, Tucson, AZ 85712. The listed phone number is (520) 436-3922.

What is Fourth Wall Wellness LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

When was this NPI record last updated?

The NPPES record for Fourth Wall Wellness LLC was last updated on February 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.