Provider Demographics
NPI:1578192274
Name:OLIVER, BRIAN W (NP-C)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:W
Last Name:OLIVER
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8019 DIXIE HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-1303
Mailing Address - Country:US
Mailing Address - Phone:502-333-3121
Mailing Address - Fax:502-531-9538
Practice Address - Street 1:8019 DIXIE HWY STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-1303
Practice Address - Country:US
Practice Address - Phone:502-333-3121
Practice Address - Fax:502-531-9538
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-04
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014401363L00000X
KYAPRN3014401363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner