Provider Demographics
NPI:1255696597
Name:OLSON, OLIVER ELLIOTT (APRN-NP)
Entity type:Individual
Prefix:
First Name:OLIVER
Middle Name:ELLIOTT
Last Name:OLSON
Suffix:
Gender:M
Credentials:APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 CHAMBERLAIN LN STE 101
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2091
Mailing Address - Country:US
Mailing Address - Phone:502-472-5657
Mailing Address - Fax:
Practice Address - Street 1:3707 CHAMBERLAIN LN STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2091
Practice Address - Country:US
Practice Address - Phone:502-472-5657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1117485163W00000X
KY3007504363L00000X
CA95002557363LF0000X
CA95063617163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100211250Medicaid
KYK056822Medicare PIN