Healthcare Provider Details

I. General information

NPI: 1346915022
Provider Name (Legal Business Name): CALLISTA EVERETT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 08/13/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BUMP POND ROAD
PLYMOUTH MA
02360
US

IV. Provider business mailing address

8 HALLICK RD
PLYMOUTH MA
02360-4206
US

V. Phone/Fax

Practice location:
  • Phone: 508-291-2441
  • Fax:
Mailing address:
  • Phone: 508-944-4883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2265674
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: