Provider Demographics
NPI:1124700323
Name:OLLIES FAMILY HEALTHCARE LLC
Entity type:Organization
Organization Name:OLLIES FAMILY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-427-1344
Mailing Address - Street 1:1301 S BROADWAY AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-5268
Mailing Address - Country:US
Mailing Address - Phone:918-564-2010
Mailing Address - Fax:918-564-2080
Practice Address - Street 1:1301 S BROADWAY AVE STE 2
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-5268
Practice Address - Country:US
Practice Address - Phone:918-564-2010
Practice Address - Fax:918-564-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty