Provider Demographics
NPI:1215292057
Name:HARPER, OLLIE LORAINE (WHCNP)
Entity type:Individual
Prefix:MS
First Name:OLLIE
Middle Name:LORAINE
Last Name:HARPER
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 J R LYNCH ST
Mailing Address - Street 2:P.O. BOX 17097
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39217-0002
Mailing Address - Country:US
Mailing Address - Phone:601-979-2260
Mailing Address - Fax:601-979-2003
Practice Address - Street 1:1400 J R LYNCH ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39217-0002
Practice Address - Country:US
Practice Address - Phone:601-979-2260
Practice Address - Fax:601-979-2003
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR510769261QF0050X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical