Provider Demographics
NPI:1902836893
Name:OVERTON, KATHERINE AMELIA (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:AMELIA
Last Name:OVERTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6331
Mailing Address - Country:US
Mailing Address - Phone:559-737-4700
Mailing Address - Fax:559-734-1247
Practice Address - Street 1:31180 ROAD 72
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:CA
Practice Address - Zip Code:93227-9997
Practice Address - Country:US
Practice Address - Phone:877-960-3426
Practice Address - Fax:559-734-1247
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54757207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G547570Medicaid
CA00G547570Medicaid