Provider Demographics
NPI:1114483641
Name:OLIVE, LINDSEY BARRETT (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:BARRETT
Last Name:OLIVE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LINDSEY
Other - Middle Name:DIANA
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:401 IRVING PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-5301
Mailing Address - Country:US
Mailing Address - Phone:919-385-5060
Mailing Address - Fax:919-385-5089
Practice Address - Street 1:2138 NC HIGHWAY 42 W
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-5300
Practice Address - Country:US
Practice Address - Phone:919-585-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08728363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant