Provider Demographics
NPI:1578505525
Name:OLIVER, RONNIE D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:D
Last Name:OLIVER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862
Mailing Address - Country:US
Mailing Address - Phone:865-908-0400
Mailing Address - Fax:865-453-7009
Practice Address - Street 1:435 PARKWAY
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862
Practice Address - Country:US
Practice Address - Phone:865-908-0400
Practice Address - Fax:865-453-7009
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000743363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4092989OtherBLUE CROSS
TNP00237276OtherRRGA
TN3669453Medicaid
TN4092989OtherBLUE CROSS