Clinton D. Olsen, DNP, NP-C

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

66883094405 Issued in UT

Practice address

280 W River Park Dr
Suite 200
Provo, UT 84604-5793

Phone

(801) 223-4860

Fax

(801) 371-8993

NPI assigned

Sep 4, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Spinal Interventions, PLLC

  • Pain Medicine (Anesthesiology) Physician
  • Provo, UT
  • NPI 1053336917
  Medicare reassignment NPD

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

{
    "created_epoch": "1346716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346716800000",
    "number": "1225387491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 RIVER PARK DR",
            "address_2": "SUITE 200",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846045764",
            "telephone_number": "801-223-4860",
            "fax_number": "801-371-8993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 W RIVER PARK DR",
            "address_2": "SUITE 200",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846045793",
            "telephone_number": "801-223-4860",
            "fax_number": "801-371-8993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSEN",
        "first_name": "CLINTON",
        "middle_name": "D.",
        "credential": "DNP, NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-04",
        "last_updated": "2012-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "UT",
            "license": "66883094405",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "UT",
            "license": "66883098900",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mykel Blake Oliver
• Rosanne Johnson Oliver, FNP
• Jared W Ollerton, CRNA
• Erynlea Olmstead
• Allana Tenney Olsen
• Gary Olsen, SUDC
• Heather Lee Olsen
• Jessica Olsen, ACMHC
• Kaylan Diane Olsen, NP
• Kyle Richard Olsen

• Pain Medicine (Anesthesiology) Physician in Provo, UT
• Providers in Provo, UT by specialty
• Pain Medicine (Anesthesiology) Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.