Basic Information
| Provider Information | |||||||||
| NPI: | 1225320997 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OVERTON | ||||||||
| FirstName: | GAIL | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MS, LN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2423 WILLIAMS DR | ||||||||
| Address2: | STE. 107; ROOM 360 | ||||||||
| City: | GEORGETOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786283200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126860207 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2423 WILLIAMS DR | ||||||||
| Address2: | STE. 107; ROOM 360 | ||||||||
| City: | GEORGETOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786283200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126860207 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2011 | ||||||||
| LastUpdateDate: | 09/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | 0796 | NM | Y | Dietary & Nutritional Service Providers | Nutritionist | 133N00000X | DT81442 | TX | N | Dietary & Nutritional Service Providers | Nutritionist |
No ID Information.