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General NPI Number Information
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NPI Number | 1720655905
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Entity Type | Individual
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Provider Name | JASON OLIVER APRN
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Gender | Male
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 3991 DUTCHMANS LN STE 405
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City | LOUISVILLE
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State | KY
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Zip | 40207-4723
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Country | US
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Telephone | 502-899-3366
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Fax |
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Provider Business Mailing Address
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Address Line | 3024 LINCOLN TRL
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City | CRESTWOOD
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State | KY
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Zip | 40014-9759
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Country | US
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Telephone | 502-572-0031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3015078
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3015078
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License Number State | KY
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