Healthcare Provider Details

I. General information

NPI: 1891600367
Provider Name (Legal Business Name): OLIVIA WARNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 LAKESIDE DR
LYNCHBURG VA
24501-3113
US

IV. Provider business mailing address

10821 WARREN POND CT
RALEIGH NC
27614-8785
US

V. Phone/Fax

Practice location:
  • Phone: 434-544-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: