Healthcare Provider Details

I. General information

NPI: 1982154324
Provider Name (Legal Business Name): EVERETT ALLEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W HARRIS ST STE 33
EUREKA CA
95503-3929
US

IV. Provider business mailing address

2400 WASHINGTON AVE STE 100
REDDING CA
96001-2814
US

V. Phone/Fax

Practice location:
  • Phone: 707-240-4212
  • Fax:
Mailing address:
  • Phone: 530-226-7419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number63179
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-06822
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA11517
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: