Provider Demographics
NPI:1851782486
Name:OLIVER, JESSICA FISHER
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:FISHER
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:LAUREN
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1224 TROTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:854 W JAMES CAMPBELL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4659
Practice Address - Country:US
Practice Address - Phone:931-540-4255
Practice Address - Fax:931-490-4654
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19670363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily