Provider Demographics
NPI:1700545209
Name:OLSEN, KARA KERISE (NP-C)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:KERISE
Last Name:OLSEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 STONERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5043
Mailing Address - Country:US
Mailing Address - Phone:208-317-1363
Mailing Address - Fax:
Practice Address - Street 1:1155 POCATELLO CREEK RD STE A
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2949
Practice Address - Country:US
Practice Address - Phone:208-223-8898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-12
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID51885163W00000X
ID71537363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse