MEDICARE: LEVON MARCELL OVERTON PA-C

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	363A00000X	Physician Assistant	0010-00267	NC

General Provider Information

NPI Number	:	1851446223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEVON MARCELL OVERTON PA-C

Provider Business Mailing Address
First Line	:	2817 REILLY ST
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-7394
Country	:	US
Telephone Number	:	910-907-7917
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 REILLY ST
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-4104
Country	:	US
Telephone Number	:	910-907-7917
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	08/22/2022

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