Provider Demographics
NPI:1255888475
Name:TAYLOR, OLIVIA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 W 13TH ST STE 121
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-1856
Mailing Address - Country:US
Mailing Address - Phone:812-996-5780
Mailing Address - Fax:
Practice Address - Street 1:721 W 13TH ST STE 121
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1856
Practice Address - Country:US
Practice Address - Phone:812-996-5780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28168363A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health