Provider Demographics
NPI:1689412116
Name:OLIVER, MADISON KEA-GAYLE
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:KEA-GAYLE
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 1:1458 SINKING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-9201
Mailing Address - Country:US
Mailing Address - Phone:606-231-1397
Mailing Address - Fax:
Practice Address - Street 1:1458 SINKING CREEK RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-9201
Practice Address - Country:US
Practice Address - Phone:606-231-1397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1178090163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse