Provider Demographics
NPI:1164538096
Name:OLSON, KEVAN JOYCE (NP PSYCHIATRIC)
Entity Type:Individual
Prefix:MRS
First Name:KEVAN
Middle Name:JOYCE
Last Name:OLSON
Suffix:
Gender:F
Credentials:NP PSYCHIATRIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:BUTTE FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97522
Mailing Address - Country:US
Mailing Address - Phone:541-488-7341
Mailing Address - Fax:
Practice Address - Street 1:255 W STEWART AVE STE 101
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3600
Practice Address - Country:US
Practice Address - Phone:541-772-5992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR096006565N6363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health