Healthcare Provider Details

I. General information

NPI: 1164838975
Provider Name (Legal Business Name): CHRISTY YATES OVERSTREET APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 NEW HOLT RD STE C
PADUCAH KY
42001-7506
US

IV. Provider business mailing address

1397 BATTS RD
WICKLIFFE KY
42087-9559
US

V. Phone/Fax

Practice location:
  • Phone: 270-575-1010
  • Fax: 270-575-1018
Mailing address:
  • Phone: 270-625-5318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008686
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: