Provider Demographics
NPI:1295731545
Name:OVERTON-MCCOY, AMY LEIGH (GNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEIGH
Last Name:OVERTON-MCCOY
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 TRINITY BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854
Mailing Address - Country:US
Mailing Address - Phone:870-773-6467
Mailing Address - Fax:870-216-0061
Practice Address - Street 1:1307 TRINITY BOULEVARD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854
Practice Address - Country:US
Practice Address - Phone:870-773-6467
Practice Address - Fax:870-216-0061
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA001559363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR82234OtherAR BLUE CROSS BLUE SHIELD
AR146188758Medicaid
TX84P261Medicare ID - Type Unspecified
AR146188758Medicaid