Provider Demographics
NPI:1740621630
Name:OVERMYER, CORINNE ANN (RN, PMHNP)
Entity type:Individual
Prefix:MS
First Name:CORINNE
Middle Name:ANN
Last Name:OVERMYER
Suffix:
Gender:F
Credentials:RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 WEST KALAMAZOO AVE.
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007
Mailing Address - Country:US
Mailing Address - Phone:269-373-6000
Mailing Address - Fax:269-373-4951
Practice Address - Street 1:418 WEST KALAMAZOO AVE.
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007
Practice Address - Country:US
Practice Address - Phone:269-373-6000
Practice Address - Fax:269-373-4951
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704147010363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health