Healthcare Provider Details

I. General information

NPI: 1114596566
Provider Name (Legal Business Name): KAILA J OVERSTREET CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 AGRICULTURE DR
MONROEVILLE AL
36460-8686
US

IV. Provider business mailing address

201 MONROE ST STE 1600
MONTGOMERY AL
36104-3721
US

V. Phone/Fax

Practice location:
  • Phone: 251-575-3109
  • Fax:
Mailing address:
  • Phone: 334-206-7065
  • Fax: 334-206-3715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1155719
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: