Provider Demographics
NPI:1437812195
Name:RICH, OLIVE MAURY CABY (NP-C)
Entity type:Individual
Prefix:MRS
First Name:OLIVE
Middle Name:MAURY CABY
Last Name:RICH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MRS
Other - First Name:MAURY
Other - Middle Name:CABY
Other - Last Name:RICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38302-0400
Mailing Address - Country:US
Mailing Address - Phone:731-425-5752
Mailing Address - Fax:731-422-5743
Practice Address - Street 1:3568 CHERE CAROL RD
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343-3639
Practice Address - Country:US
Practice Address - Phone:731-784-7602
Practice Address - Fax:731-784-9518
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN168799363L00000X
TN30331363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner