Healthcare Provider Details

I. General information

NPI: 1558081406
Provider Name (Legal Business Name): GERALD OLIVER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OAK LEE DRIVE
RANSON WV
25438-6300
US

IV. Provider business mailing address

220 CAMPUS BLVD SUITE 210
WINCHESTER VA
22601-6300
US

V. Phone/Fax

Practice location:
  • Phone: 304-350-0001
  • Fax: 304-930-0001
Mailing address:
  • Phone: 540-536-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number119325
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: