Provider Demographics
NPI:1548874159
Name:OLIVER, SUSAN ME'CHELLE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ME'CHELLE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 M ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66935-2238
Mailing Address - Country:US
Mailing Address - Phone:785-560-3101
Mailing Address - Fax:785-200-3766
Practice Address - Street 1:1913 M ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:KS
Practice Address - Zip Code:66935-2238
Practice Address - Country:US
Practice Address - Phone:785-560-3101
Practice Address - Fax:785-200-3766
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903952363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health