Healthcare Provider Details

I. General information

NPI: 1700630928
Provider Name (Legal Business Name): KARI EVERETT CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 SAINT MICHAELS DR
SANTA FE NM
87505-7602
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-303-5000
  • Fax: 505-303-5201
Mailing address:
  • Phone: 505-303-5000
  • Fax: 505-303-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number78695
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: