Provider Demographics
NPI:1437484227
Name:OVERHOLT, JODY LYNN
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:LYNN
Last Name:OVERHOLT
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 1:1216 TEXAS CREEK LN
Mailing Address - Street 2:
Mailing Address - City:COTOPAXI
Mailing Address - State:CO
Mailing Address - Zip Code:81223-9647
Mailing Address - Country:US
Mailing Address - Phone:719-942-3073
Mailing Address - Fax:
Practice Address - Street 1:1216 TEXAS CREEK LN
Practice Address - Street 2:
Practice Address - City:COTOPAXI
Practice Address - State:CO
Practice Address - Zip Code:81223-9647
Practice Address - Country:US
Practice Address - Phone:719-942-3073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide