Healthcare Provider Details

I. General information

NPI: 1225320997
Provider Name (Legal Business Name): GAIL M OVERTON MS, LN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2423 WILLIAMS DR STE. 107; ROOM 360
GEORGETOWN TX
78628-3200
US

IV. Provider business mailing address

2423 WILLIAMS DR STE. 107; ROOM 360
GEORGETOWN TX
78628-3200
US

V. Phone/Fax

Practice location:
  • Phone: 512-686-0207
  • Fax:
Mailing address:
  • Phone: 512-686-0207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number0796
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDT81442
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: