Individual
KYNZIE OLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1301 15TH AVE W, WILLISTON, ND 58801-3821
(701) 774-7400
Mailing address
1213 15TH AVE W, WILLISTON, ND 58801-3800
(170) 572-7651
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAC0656
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1468996
—
ND
Enumeration date
09/29/2016
Last updated
08/21/2019
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