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NPI Code Detail

MEDICARE: DR. KENYA EVERETTE MD

MEDICARE: DR. KENYA EVERETTE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician4301080824MI
2207Q00000XFamily Medicine Physician036107482IL
3207Q00000XFamily Medicine Physician01050551AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205021268
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENYA EVERETTE MD
Provider Business Mailing Address
First Line : 3403 E RAYMOND ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46203-4744
Country : US
Telephone Number : 317-957-2000
Fax Number : 317-957-2050
Provider Business Practice Location Address
First Line : 2855 N KEYSTONE AVE STE 100
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46218-2790
Country : US
Telephone Number : 317-957-2300
Fax Number : 317-957-2320
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2007
Last Update Date : 02/29/2024

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Directions to “ DR. KENYA EVERETTE MD” Practice Location

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