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NPI Code Detail

MEDICARE: JOSEPHINE EVERETT

MEDICARE: JOSEPHINE EVERETT
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
1106S00000XBehavior TechnicianIN

General Provider Information

NPI Number : 1528919685
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPHINE EVERETT
Provider Business Mailing Address
First Line : 609 W MARBLE LN APT C
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47404-2357
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2010 S YOST AVE
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-3188
Country : US
Telephone Number : 812-822-0605
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2026
Last Update Date : 02/05/2026

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Directions to “ JOSEPHINE EVERETT ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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