Provider Demographics
NPI:1619581766
Name:GARY, OLIVIA N (APRN)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:N
Last Name:GARY
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 1:9321 FOUNTAIN RUN RD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN RUN
Mailing Address - State:KY
Mailing Address - Zip Code:42133-8624
Mailing Address - Country:US
Mailing Address - Phone:270-579-6954
Mailing Address - Fax:
Practice Address - Street 1:9321 FOUNTAIN RUN RD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN RUN
Practice Address - State:KY
Practice Address - Zip Code:42133-8624
Practice Address - Country:US
Practice Address - Phone:270-579-6954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-05
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily