Provider Demographics
NPI:1720619281
Name:OVERTON, HALIE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:HALIE
Middle Name:
Last Name:OVERTON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-3242
Mailing Address - Country:US
Mailing Address - Phone:214-536-6466
Mailing Address - Fax:
Practice Address - Street 1:3405 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3242
Practice Address - Country:US
Practice Address - Phone:214-536-6466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42011163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant