MEDICARE: MRS. MONYETTA S EVERETT FNP

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	207Q00000X	Family Medicine Physician	903007	MS

General Provider Information

NPI Number	:	1861969552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MONYETTA S EVERETT FNP

Provider Business Mailing Address
First Line	:	1910 MADISON AVE # 2638
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-2620
Country	:	US
Telephone Number	:	901-671-0022
Fax Number	:	219-300-5911

Provider Business Practice Location Address
First Line	:	270 TRACE COLONY PARK DR STE B
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-8810
Country	:	US
Telephone Number	:	662-429-9111
Fax Number	:	219-300-5911

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

Provider Enumeration Date	:	10/31/2018
Last Update Date	:	10/15/2025

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