Provider Demographics
NPI:1417622796
Name:OVERSHINE, CRISSIE LEA (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:CRISSIE
Middle Name:LEA
Last Name:OVERSHINE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 ASBURY DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9451
Mailing Address - Country:US
Mailing Address - Phone:870-239-1779
Mailing Address - Fax:
Practice Address - Street 1:3911 ASBURY DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9451
Practice Address - Country:US
Practice Address - Phone:870-239-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR217208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily