Healthcare Provider Details

I. General information

NPI: 1902427925
Provider Name (Legal Business Name): OLIVIA KAY SCHERM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLIVIA KAY DALTON

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N CENTER ST
LONOKE AR
72086-2005
US

IV. Provider business mailing address

4196 HIGHWAY 62 412 STE A
HARDY AR
72542-8002
US

V. Phone/Fax

Practice location:
  • Phone: 15-438-8075
  • Fax: 870-895-2164
Mailing address:
  • Phone:
  • Fax: 870-856-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-913
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: