Basic Information
| Provider Information | |||||||||
| NPI: | 1053732297 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OVERSON | ||||||||
| FirstName: | CHRISTY | ||||||||
| MiddleName: | ANNIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 405473 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303845473 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 970 MEDICAL DR STE 202 | ||||||||
| Address2: | |||||||||
| City: | BRIGHAM CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843023286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356952273 | ||||||||
| FaxNumber: | 4356952278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2013 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 355394-3102 | UT | N | Nursing Service Providers | Registered Nurse | 364S00000X | 355394-4402 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist |
No ID Information.