Individual
KRISTIE OLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
260 CREST RD, SUITE 103, SAINT ALBANS, VT 05478-9503
(802) 524-8911
Mailing address
260 CREST RD, SUITE 103, SAINT ALBANS, VT 05478-9503
(802) 524-8911
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
055.0031181
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
055.0031181
VT STATE LICENSE
VT
01
—
1102040
NCCPA
CA
01
—
PA21832
STATE OF CALIFORNIA- PA LICENSE
CA
Enumeration date
09/13/2011
Last updated
10/08/2015
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