Provider Demographics
NPI:1568924108
Name:LAFOLLETTE, OLIVIA KALYN
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:KALYN
Last Name:LAFOLLETTE
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-567-3100
Mailing Address - Fax:859-567-1094
Practice Address - Street 1:4831 US HIGHWAY 42 W
Practice Address - Street 2:
Practice Address - City:GHENT
Practice Address - State:KY
Practice Address - Zip Code:41045-9001
Practice Address - Country:US
Practice Address - Phone:859-567-3100
Practice Address - Fax:859-567-1094
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013263363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily