Provider Demographics
NPI:1407928658
Name:OLIVER, ANDREA D (APRN)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:D
Last Name:OLIVER
Suffix:
Gender:F
Credentials:APRN
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 819
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633-0819
Mailing Address - Country:US
Mailing Address - Phone:903-693-3400
Mailing Address - Fax:
Practice Address - Street 1:105 COTTAGE RD STE B
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TX
Practice Address - Zip Code:75633-1507
Practice Address - Country:US
Practice Address - Phone:936-332-3042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX572471363LF0000X
TXAP113626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752735077OtherTAX ID
TX170637601Medicaid
TX170637602Medicaid
TX00374KOtherBLUE CROSS RHC