Healthcare Provider Details

I. General information

NPI: 1700647955
Provider Name (Legal Business Name): AMY RENEE OLIVER MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CLIFTY ST STE 2
SOMERSET KY
42503-1710
US

IV. Provider business mailing address

600 CLIFTY ST STE 2
SOMERSET KY
42503-1710
US

V. Phone/Fax

Practice location:
  • Phone: 606-678-0026
  • Fax: 606-678-0047
Mailing address:
  • Phone: 606-678-0026
  • Fax: 606-678-0047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4012046
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4012046
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: