Healthcare Provider Details

I. General information

NPI: 1063202166
Provider Name (Legal Business Name): SAVANNAH OLIVER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 INTERSTATE DR
GRAYSON KY
41143-1704
US

IV. Provider business mailing address

PO BOX 550
VANCEBURG KY
41179-0550
US

V. Phone/Fax

Practice location:
  • Phone: 606-474-0669
  • Fax:
Mailing address:
  • Phone: 606-796-3029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4036929
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: