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General NPI Number Information
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NPI Number | 1861969552
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Entity Type | Individual
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Provider Name | MONYETTA S EVERETT FNP
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Gender | Female
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Dates
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Enumeration Date | 10/31/2018
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 270 TRACE COLONY PARK DR STE B
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City | RIDGELAND
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State | MS
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Zip | 39157-8810
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Country | US
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Telephone | 662-429-9111
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Fax | 219-300-5911
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Provider Business Mailing Address
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Address Line | 1910 MADISON AVE # 2638
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City | MEMPHIS
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State | TN
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Zip | 38104-2620
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Country | US
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Telephone | 901-671-0022
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Fax | 219-300-5911
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 903007
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License Number State | MS
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