Provider Demographics
NPI:1548010366
Name:OLIVER, KIMBERLY JUNE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JUNE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 W 86TH ST STE 360
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1799
Mailing Address - Country:US
Mailing Address - Phone:317-798-0238
Mailing Address - Fax:
Practice Address - Street 1:3901 W 86TH ST STE 360
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1799
Practice Address - Country:US
Practice Address - Phone:317-798-0238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300074321Medicaid