Provider Demographics
NPI:1265728836
Name:OLIVER, JAYNE FERGUSON (FPMHNP)
Entity type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:FERGUSON
Last Name:OLIVER
Suffix:
Gender:F
Credentials:FPMHNP
Other - Prefix:MS
Other - First Name:JAYNE
Other - Middle Name:GRAY
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:281 CENTURY LN
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77418-3919
Mailing Address - Country:US
Mailing Address - Phone:936-254-4231
Mailing Address - Fax:
Practice Address - Street 1:1414 S FRAZIER ST STE 105-106
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-4453
Practice Address - Country:US
Practice Address - Phone:936-441-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120886363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287580905Medicaid