Provider Demographics
NPI:1407406051
Name:OLSON, KATIE NADINE
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:NADINE
Last Name:OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5929 BALCONES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4280
Mailing Address - Country:US
Mailing Address - Phone:512-550-1800
Mailing Address - Fax:
Practice Address - Street 1:3901 N NAVARRO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2622
Practice Address - Country:US
Practice Address - Phone:361-573-0713
Practice Address - Fax:361-575-0713
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143050363L00000X
TX779993163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse