MEDICARE: MS. STEPHANIE EVERS

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
1	363LF0000X	Family Nurse Practitioner	5003351	NC

General Provider Information

NPI Number	:	1679599146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE EVERS

Provider Business Mailing Address
First Line	:	3820 BRIDGES ST STE A
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-2979
Country	:	US
Telephone Number	:	252-728-8550
Fax Number	:	252-222-5855

Provider Business Practice Location Address
First Line	:	3820 BRIDGES ST STE A
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-2979
Country	:	US
Telephone Number	:	252-728-8550
Fax Number	:	252-222-5855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	02/26/2015

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