Provider Demographics
NPI:1912270125
Name:OLSON, KATHY L (APRN)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:OLSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 BERGER RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-4522
Mailing Address - Country:US
Mailing Address - Phone:270-366-0960
Mailing Address - Fax:
Practice Address - Street 1:242 BERGER RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-4522
Practice Address - Country:US
Practice Address - Phone:270-366-0960
Practice Address - Fax:270-554-1108
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX835269363LP0200X, 363LP0200X
KY3007339363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100225560Medicaid
KY7100304720Medicaid