Healthcare Provider Details

I. General information

NPI: 1417181546
Provider Name (Legal Business Name): JULIE OVERBOE JARVIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 KENNARD ST
MAPLEWOOD MN
55109-5465
US

IV. Provider business mailing address

3100 KENNARD ST
MAPLEWOOD MN
55109-5465
US

V. Phone/Fax

Practice location:
  • Phone: 651-225-5445
  • Fax: 612-713-6727
Mailing address:
  • Phone: 651-225-5445
  • Fax: 612-713-6727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number12325
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number390200000X
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number12325
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number53581
License Number StateMN
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number53581
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: