Provider Demographics
NPI:1063059988
Name:OVERBY, RUSHTON (HIS)
Entity type:Individual
Prefix:
First Name:RUSHTON
Middle Name:
Last Name:OVERBY
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 JOHNSTON ST STE 502
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5334
Mailing Address - Country:US
Mailing Address - Phone:337-294-8081
Mailing Address - Fax:337-335-0015
Practice Address - Street 1:1625 E COUNTY LINE RD STE 520
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-1833
Practice Address - Country:US
Practice Address - Phone:601-991-9661
Practice Address - Fax:601-991-1916
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSHA0633237700000X
LA1290237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist