1285129460 NPI number — MISS LOTTIE MARIE EVERETT MSN APRN FNP-C

Table of content: MISS LOTTIE MARIE EVERETT MSN APRN FNP-C (NPI 1285129460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285129460 NPI number — MISS LOTTIE MARIE EVERETT MSN APRN FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVERETT
Provider First Name:
LOTTIE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MSN APRN FNP-C
Provider Gender Code:
F

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:
1285129460
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6033 SANDHURST LN APT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75206-4719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-823-8057
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1925 E BELT LINE RD STE 208
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75006-5826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-666-9200
Provider Business Practice Location Address Fax Number:
469-900-8090
Provider Enumeration Date:
06/29/2018

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: 363LF0000X , with the licence number:  AP140418 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1285129460 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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