Provider Demographics
NPI:1538265749
Name:KEMP, OLAN BAXTER (MD)
Entity type:Individual
Prefix:DR
First Name:OLAN
Middle Name:BAXTER
Last Name:KEMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:POLLOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28573-0068
Mailing Address - Country:US
Mailing Address - Phone:910-938-3099
Mailing Address - Fax:
Practice Address - Street 1:4275 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-1100
Practice Address - Country:US
Practice Address - Phone:910-938-3099
Practice Address - Fax:910-938-3243
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD23535207Q00000X
NC2021-01888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1511077Medicaid
TNTN0106OtherAMERICHOICE
TN4139154OtherBLUE CROSS
TN3096800Medicaid
TN3096807Medicaid
TN4184953OtherBCBS
TN3096807Medicare ID - Type UnspecifiedTULLAHOMA HMA PHYSICIAN
G19074Medicare UPIN
TN3096802Medicare ID - Type Unspecified
TN3096807Medicaid