Provider Demographics
NPI:1316706328
Name:LANIER, OLIVIA STARKS (APRN)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:STARKS
Last Name:LANIER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39530-1620
Mailing Address - Country:US
Mailing Address - Phone:228-424-3734
Mailing Address - Fax:
Practice Address - Street 1:147 REYNOIR ST STE 101
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-4119
Practice Address - Country:US
Practice Address - Phone:228-374-2051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906365363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner