Provider Demographics
NPI:1639474794
Name:OVERTON, VICKY LYNN (LPTN)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:LYNN
Last Name:OVERTON
Suffix:
Gender:F
Credentials:LPTN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 LEISUREWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6207
Mailing Address - Country:US
Mailing Address - Phone:501-554-0271
Mailing Address - Fax:
Practice Address - Street 1:12 LEISUREWOOD LN
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6207
Practice Address - Country:US
Practice Address - Phone:501-554-0271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARTO1703167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician