Provider Demographics
NPI:1992226351
Name:STIVERS, OLIVIA JUSTINE (APRN)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JUSTINE
Last Name:STIVERS
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6302 HIGHWAY 44 E
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-6816
Mailing Address - Country:US
Mailing Address - Phone:502-215-6300
Mailing Address - Fax:
Practice Address - Street 1:6302 HIGHWAY 44 E
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6816
Practice Address - Country:US
Practice Address - Phone:502-215-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100480680Medicaid
KYK249870OtherMEDICARE