Provider Demographics
NPI:1083168876
Name:EVERLY, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:EVERLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3719
Mailing Address - Country:US
Mailing Address - Phone:740-652-5191
Mailing Address - Fax:740-422-8009
Practice Address - Street 1:159 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3719
Practice Address - Country:US
Practice Address - Phone:740-652-5191
Practice Address - Fax:740-422-8009
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6401718251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health