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1447469804

NPI Code Detail

MEDICARE: DR. MARY LEE EVERS PHD

MEDICARE: DR. MARY LEE EVERS PHD

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
1	103TB0200X	Cognitive & Behavioral Psychologist	1410	NC
2	103TC2200X	Clinical Child & Adolescent Psychologist	1410	NC
3	103TH0004X	Health Psychologist	1410	NC
4	103TM1800X	Intellectual & Developmental Disabilities Psychologist	1410	NC
5	103TC0700X	Clinical Psychologist	1410	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0345A	OTHER	NC	NC BCBS

General Provider Information

NPI Number	:	1447469804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY LEE EVERS PHD

Provider Business Mailing Address
First Line	:	PO BOX 640
Second Line	:
City	:	ROANOKE RAPIDS
State	:	NC
Zip	:	27870-0640
Country	:	US
Telephone Number	:	252-536-5440
Fax Number	:	252-536-5444

Provider Business Practice Location Address
First Line	:	2064 NC HIGHWAY 125
Second Line	:
City	:	ROANOKE RAPIDS
State	:	NC
Zip	:	27870-9436
Country	:	US
Telephone Number	:	252-536-5000
Fax Number	:	252-536-2258

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	02/07/2019

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Practice Location Address:

2066 NC HIGHWAY 125
ROANOKE RAPIDS, NC
27870-9436

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Practice Fax:

1639105042 — MS. KRISTEN MICHELLE DORSEY M.D.
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1487668976 — DR. HOLLY VIRGINIA MACKENNA M.D.
Practice Location Address:

2066 NC HIGHWAY 125
ROANOKE RAPIDS, NC
27870-9436

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Practice Fax: 252-536-2258

1376638312 — SHERBY BROWN ARNP-C
Practice Location Address:

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ROANOKE RAPIDS, NC
27870-9436

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1669500997 — RURAL HEALTH GROUP, INC.
Practice Location Address:

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ROANOKE RAPIDS, NC
27870-9436

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1386838159 — DR. JAYA BAJAJ M.D.
Practice Location Address:

2066 NC HIGHWAY 125
ROANOKE RAPIDS, NC
27870-9436

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Practice Fax: 252-536-5444

Directions to “ DR. MARY LEE EVERS PHD” Practice Location

Language	Start Address	Practice Location

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