Provider Demographics
NPI:1316505217
Name:OVERTON, KELSEY ANNE (APRN)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:ANNE
Last Name:OVERTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:KELSEY
Other - Middle Name:ANNE
Other - Last Name:BRANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4444 E FLETCHER AVE STE C
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4905
Mailing Address - Country:US
Mailing Address - Phone:813-903-0060
Mailing Address - Fax:
Practice Address - Street 1:4444 E FLETCHER AVE STE B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4905
Practice Address - Country:US
Practice Address - Phone:813-903-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9417135363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics