Christina J Olive, FNP-BC
Individual provider Active NPI Family Nurse Practitioner · Amanda, OH
NPI 1447699129 · NPPES record last updated Nov 8, 2016
Key facts
- NPI
- 1447699129
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- COA.14524-NP (OH)
- Practice address
- 123 E Main St
Amanda, OH 43102-1111 - Phone
- (740) 969-4828
- Fax
- (740) 969-4818
- NPI assigned
- Jun 17, 2013
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220720000048 | TX | Order and Referring Only - Nurse Practitioner | 2264674969 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| COA.14524-NP | OH | MD | Family Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | COA.14524-NP | OH | Yes |
Addresses
Primary practice location
123 E Main St
Amanda, OH 43102-1111
Mailing address
1153 E Main St
PO Box 2563
Lancaster, OH 43130-4056
Phone (740) 687-8990
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0087204 | Medicaid | OH |
NPI Registry JSON
{
"created_epoch": "1371427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478563200000",
"number": "1447699129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1153 E MAIN ST",
"address_2": "PO BOX 2563",
"city": "LANCASTER",
"state": "OH",
"postal_code": "431304056",
"telephone_number": "740-687-8990",
"fax_number": "740-687-8230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "123 E MAIN ST",
"city": "AMANDA",
"state": "OH",
"postal_code": "431021111",
"telephone_number": "740-969-4828",
"fax_number": "740-969-4818"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLIVE",
"first_name": "CHRISTINA",
"middle_name": "J",
"name_prefix": "Mrs.",
"credential": "FNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-17",
"last_updated": "2016-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "OH",
"license": "COA.14524-NP",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0087204",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Amanda, OH
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- Caullette Kilby
- Samantha Jayne Parry
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- Heather Schultz
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All providers in Amanda, OH · Family Nurse Practitioner in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 8, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.