Provider Demographics
NPI:1912979485
Name:OVERTON-BARNES, REGINA (FNP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:OVERTON-BARNES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 94670
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73143-4670
Mailing Address - Country:US
Mailing Address - Phone:405-682-3303
Mailing Address - Fax:405-384-6793
Practice Address - Street 1:2240 SUTHERLAND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:865-588-8831
Practice Address - Fax:865-588-8841
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN110607163W00000X
TNAPN7412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3640102Medicaid
TN103I016543Medicare PIN
TNQ40829Medicare UPIN