Healthcare Provider Details

I. General information

NPI: 1235096876
Provider Name (Legal Business Name): MS. MELISSA ANN OVERTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 BRAGG ST
WARREN AR
71671-2500
US

IV. Provider business mailing address

206 BRAGG ST
WARREN AR
71671-2500
US

V. Phone/Fax

Practice location:
  • Phone: 870-226-7844
  • Fax: 870-226-2798
Mailing address:
  • Phone: 870-226-7844
  • Fax: 870-226-2798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number15462
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: