Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Krystle Lacole Oliver

Individual provider Nurse Practitioner · NPI 1417543406

Krystle Lacole Oliver is a Nurse Practitioner in Minneapolis, Minnesota. Qualified in 2020, 6 years ago. Practices with Office of Internal Medicine, PC, a 9-clinician group and accepts Medicare assignment. Licensed in Tennessee.

Years since qualifying
6
Licensed in
TN
In the registry since
2020
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Practice location Address checks out

100 Washington Ave S
Minneapolis, MN 55401-2110
Phone: (901) 337-6920
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 28734 (TN)

Record details

NPI number1417543406
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedDecember 15, 2020
Last updated in NPPESDecember 19, 2020
Certification dateDecember 19, 2020
Mailing address100 Washington Ave S, Minneapolis, MN 55401-2110

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Office Of Internal Medicine, Pc — 9 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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