Provider Demographics
NPI:1083335897
Name:OVERSHINE, KENZIE
Entity Type:Individual
Prefix:
First Name:KENZIE
Middle Name:
Last Name:OVERSHINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7483 HIGHWAY 34 W
Mailing Address - Street 2:
Mailing Address - City:BEECH GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72412-8709
Mailing Address - Country:US
Mailing Address - Phone:870-450-3279
Mailing Address - Fax:
Practice Address - Street 1:2811 CREEK DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5377
Practice Address - Country:US
Practice Address - Phone:870-203-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD16299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist