Healthcare Provider Details

I. General information

NPI: 1821446915
Provider Name (Legal Business Name): JESSE OLIVER NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2016
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 FOSTER AVE
ARCATA CA
95521-5986
US

IV. Provider business mailing address

704 LEBEC RD
LEBEC CA
93243-4049
US

V. Phone/Fax

Practice location:
  • Phone: 707-826-8610
  • Fax: 707-826-8623
Mailing address:
  • Phone: 661-248-5250
  • Fax: 661-248-5279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: