Olive Branch Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

OLIVE BRANCH DERMATOLOGY LLC

Practice address

4721 Chace Cir
Hoover, AL 35244-3700

Phone

(205) 266-9011

NPI assigned

Dec 4, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Amena Raja Alkeswani, MDNPI 1962023556

Title

Practice Owner

Phone

(727) 504-5883

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amena Raja Alkeswani, M.D.

  • Dermatology Physician
  • Hoover, AL
  • NPI 1962023556
  Medicare reassignment NPD Authorized official
• Amber Deskins, CRNA

  • Certified Registered Nurse Anesthetist
  • Hoover, AL
  • NPI 1568829950
  NPD
• Cari Evans

  • Certified Registered Nurse Anesthetist
  • Birmingham, AL
  • NPI 1134586019
  NPD
• Katherine J Herbst, PA-C

  • Medical Physician Assistant
  • Hoover, AL
  • NPI 1861199887
  NPD
• Leah Byerly Smith, PA-C

  • Physician Assistant
  • Hoover, AL
  • NPI 1669179685
  NPD
• Catesby Penn Ulversoy, PA

  • Physician Assistant
  • Hoover, AL
  • NPI 1407589534

  Single Specialty

  NPD
• Jodi Bloomston, CRNA

  • Certified Registered Nurse Anesthetist
  • Birmingham, AL
  • NPI 1801849187
  NPD (past)
• Sylvia A Eldridge, PA

  • Surgical Physician Assistant
  • Hoover, AL
  • NPI 1609978576
  NPD (past)
• Catherine Francesca Gillespie, PA-C

  • Physician Assistant
  • Birmingham, AL
  • NPI 1013575943
  NPD (past)
• Jamie Gober

  • Surgical Physician Assistant
  • Vestavia, AL
  • NPI 1902332364
  NPD (past)
• Sidney Lynn Goscinski, PA

  • Physician Assistant
  • Birmingham, AL
  • NPI 1467969196
  NPD (past)
• Charles Austin Hunt II, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Hoover, AL
  • NPI 1699784538
  NPD (past)

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

{
    "created_epoch": "1733270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781136000000",
    "number": "1750197794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 36263",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352366263",
            "telephone_number": "205-266-9011",
            "fax_number": "903-200-1515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4721 CHACE CIR",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352443700",
            "telephone_number": "205-266-9011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 Towncenter Blvd Ste C",
            "address_purpose": "LOCATION",
            "city": "Tuscaloosa",
            "state": "AL",
            "postal_code": "354061847",
            "country_code": "US",
            "telephone_number": "205-266-9011",
            "fax_number": "903-200-1515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OLIVE BRANCH DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-04",
        "last_updated": "2026-06-11",
        "certification_date": "2026-06-11",
        "status": "A",
        "authorized_official_last_name": "ALKESWANI",
        "authorized_official_first_name": "AMENA",
        "authorized_official_middle_name": "RAJA",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "727-504-5883",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A1254956",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emme Lane Novoa, FNP
• Nuevo Camino Counseling LLC
• Nursing Solutions, Inc.
• Jeffrey Phillip Nuttall
• Charles R. Oehrlein, DPM
• Braden Wright Olive, DPT
• Samantha Oliver
• One Medical Group, P.C.
• Option Care Enterprises Inc
• Option Care Enterprises, Inc.

• Dermatology Physician in Hoover, AL
• Providers in Hoover, AL by specialty
• Dermatology Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.