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NPI Code Detail

MEDICARE: DR. KERRI NICOLE EVERSON D.D.S.

MEDICARE: DR. KERRI NICOLE EVERSON D.D.S.
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
1122300000XDentist8426TN

General Provider Information

NPI Number : 1699821496
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KERRI NICOLE EVERSON D.D.S.
Provider Business Mailing Address
First Line : 6858 AVENSONG LN
Second Line :
City : KNOXVILLE
State : TN
Zip : 37909-1262
Country : US
Telephone Number : 865-558-3199
Fax Number :
Provider Business Practice Location Address
First Line : 820 N KENTUCKY ST
Second Line :
City : KINGSTON
State : TN
Zip : 37763-2635
Country : US
Telephone Number : 865-717-3586
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2007
Last Update Date : 07/08/2007

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