Provider Demographics
NPI:1225320997
Name:OVERTON, GAIL M (MS, LN)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:M
Last Name:OVERTON
Suffix:
Gender:F
Credentials:MS, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 WILLIAMS DR
Mailing Address - Street 2:STE. 107; ROOM 360
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3200
Mailing Address - Country:US
Mailing Address - Phone:512-686-0207
Mailing Address - Fax:
Practice Address - Street 1:2423 WILLIAMS DR
Practice Address - Street 2:STE. 107; ROOM 360
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3200
Practice Address - Country:US
Practice Address - Phone:512-686-0207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0796133N00000X
TXDT81442133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist