Provider Demographics
NPI:1194008813
Name:STALLARD, OLIVIA F (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:F
Last Name:STALLARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:OLIVIA
Other - Middle Name:F
Other - Last Name:HATCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:350 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2261
Mailing Address - Country:US
Mailing Address - Phone:724-774-3232
Mailing Address - Fax:
Practice Address - Street 1:350 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2261
Practice Address - Country:US
Practice Address - Phone:724-774-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055076363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant