Healthcare Provider Details

I. General information

NPI: 1275787012
Provider Name (Legal Business Name): DEBRA G OVERTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EMANCIPATION DR
HAMPTON VA
23667-0001
US

IV. Provider business mailing address

19 DAVID DR
HAMPTON VA
23666-1878
US

V. Phone/Fax

Practice location:
  • Phone: 757-722-9961
  • Fax: 757-728-3392
Mailing address:
  • Phone: 757-827-8360
  • Fax: 757-728-3392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number0001131979
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024175839
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: