Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 BEAUMONT CENTRE CIR
LEXINGTON KY
40513-1961
US

IV. Provider business mailing address

100 EDEN PL APT 305
NICHOLASVILLE KY
40356-6536
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5544
  • Fax:
Mailing address:
  • Phone: 412-398-0741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberTC090
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberTC090
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTC090
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: