Provider Demographics
NPI:1134617996
Name:OLIVER, HARLEY MICHELLE
Entity type:Individual
Prefix:
First Name:HARLEY
Middle Name:MICHELLE
Last Name:OLIVER
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 1:6720 GRELOT ROAD SUITE A
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-2676
Mailing Address - Country:US
Mailing Address - Phone:251-633-5155
Mailing Address - Fax:251-633-5125
Practice Address - Street 1:6720 GRELOT ROAD SUITE A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-2676
Practice Address - Country:US
Practice Address - Phone:251-633-5155
Practice Address - Fax:251-633-5125
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA1387363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical