Healthcare Provider Details

I. General information

NPI: 1750716692
Provider Name (Legal Business Name): REBEKAH HOUSTON OVERSTREET FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 CENTRAL AVE
COLDWATER MS
38618-3915
US

IV. Provider business mailing address

423 CENTRAL AVE
COLDWATER MS
38618-3915
US

V. Phone/Fax

Practice location:
  • Phone: 662-622-7011
  • Fax:
Mailing address:
  • Phone: 662-622-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR885859
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: