Provider Demographics
NPI:1467987073
Name:OLIVER, CAROL HAYDEN (PPCNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:HAYDEN
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PROFESSIONAL COURT
Mailing Address - Street 2:SUITE C
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-8808
Mailing Address - Country:US
Mailing Address - Phone:304-263-8853
Mailing Address - Fax:304-263-6178
Practice Address - Street 1:2000 PROFESSIONAL CT STE C
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-8803
Practice Address - Country:US
Practice Address - Phone:304-263-8853
Practice Address - Fax:304-263-6178
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV57672363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics