Provider Demographics
NPI:1326799024
Name:OLIVER, KATELYN MCCALL (CRNP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MCCALL
Last Name:OLIVER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 N 20TH ST BLDG 24
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5442
Mailing Address - Country:US
Mailing Address - Phone:334-745-4646
Mailing Address - Fax:334-745-0633
Practice Address - Street 1:122 N 20TH ST BLDG 24
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5442
Practice Address - Country:US
Practice Address - Phone:334-745-4646
Practice Address - Fax:334-745-0633
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-143605363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty