Healthcare Provider Details

I. General information

NPI: 1740488972
Provider Name (Legal Business Name): WILMA SUZANNE OLVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 W COLLIN RAYE DR
DE QUEEN AR
71832-2135
US

IV. Provider business mailing address

2904 ARKANSAS BLVD
TEXARKANA AR
71854-2536
US

V. Phone/Fax

Practice location:
  • Phone: 870-584-7115
  • Fax: 870-642-3388
Mailing address:
  • Phone: 870-773-4655
  • Fax: 870-772-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: