Provider Demographics
NPI:1801403217
Name:OVERTON, JESSICA EVELYN (NP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:EVELYN
Last Name:OVERTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 775641
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5641
Mailing Address - Country:US
Mailing Address - Phone:314-543-6979
Mailing Address - Fax:314-364-6321
Practice Address - Street 1:6801 PHOENIX AVE STE 2
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5299
Practice Address - Country:US
Practice Address - Phone:479-384-5378
Practice Address - Fax:479-385-5379
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2024-11-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AR125285363LF0000X
LA230062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily