1902836893 NPI number — KATHERINE AMELIA OVERTON M.D

Table of content: KATHERINE AMELIA OVERTON M.D (NPI 1902836893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902836893 NPI number — KATHERINE AMELIA OVERTON M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OVERTON
Provider First Name:
KATHERINE
Provider Middle Name:
AMELIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902836893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 E CENTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISALIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93291-6331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-737-4700
Provider Business Mailing Address Fax Number:
559-734-1247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31180 ROAD 72
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOSHEN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93227-9997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-960-3426
Provider Business Practice Location Address Fax Number:
559-734-1247
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  G54757 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G547570 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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