Healthcare Provider Details

I. General information

NPI: 1992421762
Provider Name (Legal Business Name): KIMBERLY A OVERTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 CREEKSIDE CT
HENDERSONVILLE TN
37075-3063
US

IV. Provider business mailing address

106 CREEKSIDE CT
HENDERSONVILLE TN
37075-3063
US

V. Phone/Fax

Practice location:
  • Phone: 615-495-0707
  • Fax:
Mailing address:
  • Phone: 615-495-0707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number225471
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: