MEDICARE: DUSTIN BROOKE OVERTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	71014855A	IN

General Provider Information

NPI Number	:	1659142685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN BROOKE OVERTON

Provider Business Mailing Address
First Line	:	319 E SOUTH ST
Second Line	:
City	:	WINCHESTER
State	:	IN
Zip	:	47394-2230
Country	:	US
Telephone Number	:	765-209-0119
Fax Number	:

Provider Business Practice Location Address
First Line	:	2060 N STATE ROAD 1
Second Line	:
City	:	CAMBRIDGE CITY
State	:	IN
Zip	:	47327-9436
Country	:	US
Telephone Number	:	765-478-5395
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2024
Last Update Date	:	01/09/2024

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Directions to “ DUSTIN BROOKE OVERTON ” Practice Location

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