Provider Demographics
NPI:1396486551
Name:LEBER, OLIVIA (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:
Last Name:LEBER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1976 EASTRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-2201
Mailing Address - Country:US
Mailing Address - Phone:601-835-7536
Mailing Address - Fax:
Practice Address - Street 1:1976 EASTRIDGE CIR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-2201
Practice Address - Country:US
Practice Address - Phone:601-835-7536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-04
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905174363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner