Healthcare Provider Details

I. General information

NPI: 1417593682
Provider Name (Legal Business Name): COREY N EVERETT RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 SW 11TH TER
TOPEKA KS
66604-2033
US

IV. Provider business mailing address

5230 SW 11TH TER
TOPEKA KS
66604-2033
US

V. Phone/Fax

Practice location:
  • Phone: 785-414-0946
  • Fax:
Mailing address:
  • Phone: 785-414-0946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number2012033303
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number16-03485
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: