Healthcare Provider Details

I. General information

NPI: 1942199385
Provider Name (Legal Business Name): OLIVIA CLAIRE GOERDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 CHARLES T WETHINGTON BUILDING
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

4057 MOONCOIN WAY APT 10301
LEXINGTON KY
40515-6157
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-5001
  • Fax:
Mailing address:
  • Phone: 412-398-0741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: