Provider Demographics
NPI:1043903750
Name:OLIVER, REBBECCA (AGACNP)
Entity type:Individual
Prefix:MS
First Name:REBBECCA
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 CAROLCREST LN APT 221
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-7805
Mailing Address - Country:US
Mailing Address - Phone:936-215-3392
Mailing Address - Fax:
Practice Address - Street 1:1900 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-2105
Practice Address - Country:US
Practice Address - Phone:936-327-1015
Practice Address - Fax:888-815-1346
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1123734363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner