Provider Demographics
NPI:1962492249
Name:OVERTON, TIAMEKO ROCHELLE (NP)
Entity Type:Individual
Prefix:MRS
First Name:TIAMEKO
Middle Name:ROCHELLE
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:PO BOX 51742
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1742
Mailing Address - Country:US
Mailing Address - Phone:337-593-9099
Mailing Address - Fax:337-769-8509
Practice Address - Street 1:105 CORPORATE BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3850
Practice Address - Country:US
Practice Address - Phone:337-593-9099
Practice Address - Fax:337-769-8509
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04787363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1630420Medicaid
LA4H676Medicare UPIN