=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629781083
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRISTA DAVIE OVERBY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2022
-----------------------------------------------------
Last Update Date | 12/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 447 SUTTER ST #405 MB 171
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-795-2706
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 447 SUTTER ST #405 MB 171
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-795-2706
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 95023741
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------