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General NPI Number Information
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NPI Number | 1871439273
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Entity Type | Organization
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Legal Business Name | EVERGREEN THERAPEUTICS LLC
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 1492 CHIMNEY ROCK DR
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City | KERNERSVILLE
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State | NC
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Zip | 27284-8905
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Country | US
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Telephone | 336-252-4568
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Fax |
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Provider Business Mailing Address
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Address Line | 5164 REIDSVILLE RD STE 215
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City | WALKERTOWN
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State | NC
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Zip | 27051-9770
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Country | US
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Telephone | 336-252-4568
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIEF EXECUTIVE OFFICER
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Name | LYNDSEY ISLEY
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Credential | LBA, BCBA
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Telephone | 336-252-4434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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