NPIMap

Individual provider Active NPI

Olivia Jean Wall Petrie, PA-C

  • Physician Assistant
  • Girdwood, AK
National Provider Identifier
1124416334
Registry record updated Mar 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PADA1224 Issued in AK
Practice address
1130 Lindblad Ave
Girdwood, AK 99587
Phone
(907) 783-1355
Fax
(907) 783-1357
NPI assigned
Dec 23, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PADA1224 AK Primary

Addresses

Primary practice location

1130 Lindblad Ave
Girdwood, AK 99587

Mailing address

PO Box 1130
Girdwood, AK 99587-1130
Phone (907) 783-1355

Other identifiers 1

IdentifierTypeStateIssuer
1626495MedicaidAK

Other names 1

  • Ms. Olivia Jean Wall Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150321000002 AK Practitioner - Physician Assistant 8921325424 Reassigns benefits to 2 organizations
I20180511001458 TX Practitioner - Physician Assistant 8921325424 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Girdwood Health Clinic, Inc.Group PAC ID 4688836216, 8 clinicians

Practice addresses (Care Compare)

131 Lindblad Ave
Girdwood, AK 99587-1130
Phone (907) 783-1355

PO Box
Girdwood, AK 99587

Hospital & facility affiliations

  • Providence Alaska Medical Center Hospital, Anchorage, AK, CCN 020001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Alaska Regional Health Consortium CurrentSince Aug 27, 2019 Accepting new patients
Southeast Alaska Regional Health Consortium CurrentSince Aug 27, 2019 Accepting new patients
Eastern Aleutian Tribes, Inc CurrentSince Feb 12, 2015 Accepting new patients
Southeast Alaska Regional Health Consortium Current Accepting new patients
Eastern Aleutian Tribes, Inc. Past Accepting new patients
Girdwood Clinic, Inc. Past Accepting new patients

Locations

3380 C St
Ste 100
Anchorage, AK 99503
Phone (907) 277-1440

3100 Channel Dr
Ste 300
Juneau, AK 99801
Phone (907) 463-4000

222 Tongass Dr
Sitka, AK 99835
Phone (907) 966-8423

209 Moller Ave
Sitka, AK 99835
Phone (907) 747-1722

209 Moller Ave
Ste 100
Sitka, AK 99835
Phone (907) 747-1771

Interoperability endpoints

  • Direct secure messaging: oliviap@direct-searhc.org
  • Direct secure messaging: olivia.petrie.1@8748.direct.athenahealth.com

Organizations & group practices 8

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

Hospital & facility affiliations 1

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": "1419292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772582400000",
    "number": "1124416334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1130",
            "city": "GIRDWOOD",
            "state": "AK",
            "postal_code": "995871130",
            "telephone_number": "907-783-1355",
            "fax_number": "907-783-1357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 LINDBLAD AVE",
            "city": "GIRDWOOD",
            "state": "AK",
            "postal_code": "99587",
            "telephone_number": "907-783-1355",
            "fax_number": "907-783-1357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRIE",
        "first_name": "OLIVIA",
        "middle_name": "JEAN WALL",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-23",
        "last_updated": "2026-03-04",
        "certification_date": "2026-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "PADA1224",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1626495",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "OLIVIA",
            "last_name": "WALL",
            "middle_name": "JEAN",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Girdwood, AK

Sources for this page

Verify at the official NPI Registry.