Healthcare Provider Details

I. General information

NPI: 1356081038
Provider Name (Legal Business Name): OLIVIA TOUCHTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 WEST D. L. INGRAM BLVD BLDG 1408
APO AA
88103
US

IV. Provider business mailing address

224 WEST D. L. INGRAM BLVD BLDG 1408
CANNON AFB NM
88103
US

V. Phone/Fax

Practice location:
  • Phone: 575-904-3917
  • Fax:
Mailing address:
  • Phone: 512-761-2855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number02008740A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: