Provider Demographics
NPI:1366119539
Name:OVERBEY, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:OVERBEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4280 EL COMO WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-6648
Mailing Address - Country:US
Mailing Address - Phone:702-572-0391
Mailing Address - Fax:
Practice Address - Street 1:4850 W FLAMINGO RD STE 25A&B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3705
Practice Address - Country:US
Practice Address - Phone:702-871-9917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant