Provider Demographics
NPI:1801403217
Name:OVERTON, JESSICA EVELYN (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:EVELYN
Last Name:OVERTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 ALONZO ST
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-4008
Mailing Address - Country:US
Mailing Address - Phone:701-648-8784
Mailing Address - Fax:
Practice Address - Street 1:2419 ALONZO ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4008
Practice Address - Country:US
Practice Address - Phone:337-898-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA230062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily