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Individual

MR. TIMOTHY RAY OLIVE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ARNP

Contact information

Practice address
2011 N BROADWAY ST, POTEAU, OK 74953-2642
(918) 647-7416
(918) 647-3508
Mailing address
2011 N BROADWAY ST, POTEAU, OK 74953-2642
(918) 647-7416
(918) 647-3508

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
77830
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
77830
NURSING LICENSE
OK
Enumeration date
03/24/2011
Last updated
02/12/2019
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