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General NPI Number Information
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NPI Number | 1003366980
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Entity Type | Individual
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Provider Name | JAMES EVERITT
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Gender | Male
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 5720 W MARKHAM ST
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City | LITTLE ROCK
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State | AR
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Zip | 72205-3328
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Country | US
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Telephone | 501-805-2895
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 MCKENSIE DR
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City | BENTON
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State | AR
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Zip | 72015-4956
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | OT-A738
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License Number State | AR
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