Provider Demographics
NPI:1396248381
Name:OLLIE, CRYSTAL (APN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:OLLIE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 S BROADWAY ST
Mailing Address - Street 2:STE D
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-3819
Mailing Address - Country:US
Mailing Address - Phone:918-564-2270
Mailing Address - Fax:877-210-2506
Practice Address - Street 1:104 WALL ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4405
Practice Address - Country:US
Practice Address - Phone:918-647-8630
Practice Address - Fax:918-635-3191
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK93039363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner