Healthcare Provider Details

I. General information

NPI: 1386439065
Provider Name (Legal Business Name): OLIVIA ANITA O'HARA MSN, PMHNP
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2025
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S PARKSIDE DR
COLORADO SPRINGS CO
80910-3130
US

IV. Provider business mailing address

115 S PARKSIDE DR
COLORADO SPRINGS CO
80910-3130
US

V. Phone/Fax

Practice location:
  • Phone: 719-572-6100
  • Fax:
Mailing address:
  • Phone: 719-572-6100
  • Fax: 719-572-6089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.1001667-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: