Provider Demographics
NPI:1144946765
Name:OLIVE BRANCH PSYCHIATRICS
Entity type:Organization
Organization Name:OLIVE BRANCH PSYCHIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:CAROLYN
Authorized Official - Last Name:WELCH-OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-550-9199
Mailing Address - Street 1:PO BOX 750182
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89136-0182
Mailing Address - Country:US
Mailing Address - Phone:702-561-7564
Mailing Address - Fax:
Practice Address - Street 1:6628 SKY POINTE DR STE 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-4071
Practice Address - Country:US
Practice Address - Phone:702-550-9199
Practice Address - Fax:702-935-8946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty