=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902831464
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRYSTAL S. OVERLY ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2006
-----------------------------------------------------
Last Update Date | 04/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12385 SORRENTO RD STE B3
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32507-8656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-602-0828
-----------------------------------------------------
Fax | 850-497-6871
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38 S BLUE ANGEL PKWY # 104
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32506-6045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-529-7932
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | ARNP3248772
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------