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NPI Code Detail

MEDICARE: N. KATHLEEN EVERETT GNP

MEDICARE: N. KATHLEEN EVERETT GNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LG0600XGerontology Nurse PractitionerTN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1APN0000008254OTHERTNAPN LICENSE

General Provider Information

NPI Number : 1124161377
Entity Type Code : Individual
Provider Name (Legal Business Name) : N. KATHLEEN EVERETT GNP
Provider Business Mailing Address
First Line : PO BOX 70403
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37614-1703
Country : US
Telephone Number : 423-439-4078
Fax Number : 423-439-4060
Provider Business Practice Location Address
First Line : 207 E MYRTLE AVE
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37601-4633
Country : US
Telephone Number : 423-926-2500
Fax Number : 423-926-5999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2007
Last Update Date : 07/08/2007

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