Healthcare Provider Details

I. General information

NPI: 1508417650
Provider Name (Legal Business Name): JAMIE LYNNE OLIVER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N RUTHERFORD ST
MACON MO
63552-2020
US

IV. Provider business mailing address

1201 N RUTHERFORD ST
MACON MO
63552-2020
US

V. Phone/Fax

Practice location:
  • Phone: 660-385-8900
  • Fax: 660-385-8708
Mailing address:
  • Phone: 660-385-8900
  • Fax: 660-385-8708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019036528
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: