Healthcare Provider Details

I. General information

NPI: 1134030257
Provider Name (Legal Business Name): ANDREW JONATHAN EVERETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 MALVERN AVE
HOT SPRINGS AR
71901-7752
US

IV. Provider business mailing address

4961 DUSTY DAWN RD
CORPUS CHRISTI TX
78413-2420
US

V. Phone/Fax

Practice location:
  • Phone: 501-321-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number239578
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: