Provider Demographics
NPI:1346910072
Name:BAIRD, OLIVIA THERESE
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:THERESE
Last Name:BAIRD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 AMANDA MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3735
Mailing Address - Country:US
Mailing Address - Phone:615-714-7251
Mailing Address - Fax:
Practice Address - Street 1:2109 AMANDA MEADOW CT
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3735
Practice Address - Country:US
Practice Address - Phone:615-714-7251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY4034220367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program