Provider Demographics
NPI:1053795518
Name:OLSEN, CHARLES (NP)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:OLSEN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4567
Mailing Address - Country:US
Mailing Address - Phone:931-250-5488
Mailing Address - Fax:931-250-5667
Practice Address - Street 1:63 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4567
Practice Address - Country:US
Practice Address - Phone:931-250-5488
Practice Address - Fax:931-250-5667
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20065163WP0808X
TN20066363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health