NPIMap

Individual provider Active NPI

Timothy Ray Olive, ARNP

  • Adult Health Nurse Practitioner
  • Poteau, OK
National Provider Identifier
1033418439
Registry record updated Feb 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
77830 Issued in OK
Practice address
2011 N Broadway St
Poteau, OK 74953-2642
Phone
(918) 647-7416
Fax
(918) 647-3508
NPI assigned
Mar 24, 2011
Last updated
Feb 12, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 77830 OK Primary

Addresses

Primary practice location

2011 N Broadway St
Poteau, OK 74953-2642

Mailing address

2011 N Broadway St
Poteau, OK 74953-2642
Phone (918) 647-7416

Other identifiers 1

IdentifierTypeStateIssuer
77830OtherOKNURSING LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150625002114 OK Practitioner - Nurse Practitioner 4688985039 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1015 E Choctaw Ave
Mercy Clinic Primary Care Sallisaw
Sallisaw, OK 74955-5011
Phone (918) 774-0034

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Family First Medical Clinic Aprn-CNP PLLC CurrentSince May 18, 2015 Accepting new patients
PM Medical LLC CurrentSince Sep 1, 2025 Accepting new patients
Mercy Clinic Fort Smith Communities CurrentSince Dec 4, 2017 Accepting new patients
Mercy Clinic Fort Smith Communities CurrentSince Dec 4, 2017 Accepting new patients
Mercy Clinic Fort Smith Communities Current Accepting new patients
Haskell Regional Hospital, Inc CurrentSince Feb 21, 2021 Accepting new patients
Mercy Hospital Fort Smith Past Accepting new patients

Locations

2806 N Broadway St
Poteau, OK 74953
Phone (918) 647-7416

2110 N Broadway St
Poteau, OK 74953
Phone (918) 205-1994

213 E Redwood Ave
Sallisaw, OK 74955
Phone (918) 774-1100

1015 E Choctaw Ave
Sallisaw, OK 74955
Phone (918) 774-0034

801 W Main St
Ste D
Stigler, OK 74462
Phone (918) 413-8542

714 W Main St
Stigler, OK 74462
Phone (918) 630-6070

801 W Main St
Ste A
Stigler, OK 74462
Phone (918) 967-8010

Interoperability endpoints

  • Direct secure messaging: tolive969055@directc.mercy.net
  • FHIR API: https://fhir-usa.unify.chbase.com/org/eastokl-57038e39

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549929600000",
    "number": "1033418439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2011 N BROADWAY ST",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749532642",
            "telephone_number": "918-647-7416",
            "fax_number": "918-647-3508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2011 N BROADWAY ST",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749532642",
            "telephone_number": "918-647-7416",
            "fax_number": "918-647-3508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVE",
        "first_name": "TIMOTHY",
        "middle_name": "RAY",
        "name_prefix": "Mr.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-24",
        "last_updated": "2019-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OK",
            "license": "77830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSING LICENSE",
            "identifier": "77830",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Poteau, OK

Sources for this page

Verify at the official NPI Registry.