Ka Oliver Inc.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

A004049 Issued in AR

Legal business name

KA OLIVER INC.

Doing business as

Ozark Mountain Health and Wellness

Practice address

3810 N Front St Ste 11
Fayetteville, AR 72703-5217

Phone

(479) 387-4920

NPI assigned

Mar 7, 2018

Organization subpart

No

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

Authorized official

Name

Kelley Oliver, APRN

Title

President

Phone

(479) 387-4920

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Ozark Mountain Health and Wellness Doing business as

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

{
    "created_epoch": "1520380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1558863373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12768 N BILLINGSLEY RD",
            "city": "PRAIRIE GROVE",
            "state": "AR",
            "postal_code": "727539467",
            "telephone_number": "479-409-1029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3810 N FRONT ST STE 11",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035217",
            "telephone_number": "479-387-4920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KA OLIVER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-07",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "OLIVER",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "479-387-4920",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A004049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "5AQ83",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206672758",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ozark Mountain Health and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Nurse Practitioner in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Family Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.