1174697866 NPI number — DR. ROSS AARON EVERHARD PSYD

Table of content: DR. ROSS AARON EVERHARD PSYD (NPI 1174697866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174697866 NPI number — DR. ROSS AARON EVERHARD PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVERHARD
Provider First Name:
ROSS
Provider Middle Name:
AARON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174697866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 JOEL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT CAMPBELL
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42223-5318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-461-4018
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 JOEL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT CAMPBELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42223-5318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-461-4018
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  1291 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 432007236 . This is a "ALLIANCE BEHAVIORAL" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: V529R2 . This is a "EMPIRE BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 281496 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 432007236 . This is a "CIGNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 432007236 . This is a "HEALTHSPAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1204616 . This is a "COMMONWEALTH ADMINISTRATO" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 432007236 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 432007236 . This is a "GREAT WEST HEALTHCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 5656062 . This is a "FIRST HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: EVERROSS . This is a "CORPHEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 432007236 . This is a "MEDBEN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 089471000 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 432007236 . This is a "TRICARE NORTH REGION" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000330721 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1204616 . This is a "CHA HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 432007236 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 432007236 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 432007236 . This is a "VALUE OPTIONS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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