Provider Demographics
NPI:1093145864
Name:EVERETT, KATHERINE (MA)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:EVERETT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 ELLINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-8701
Mailing Address - Country:US
Mailing Address - Phone:919-733-5344
Mailing Address - Fax:919-733-9441
Practice Address - Street 1:2108 UMSTEAD DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27699-0001
Practice Address - Country:US
Practice Address - Phone:919-733-5344
Practice Address - Fax:919-733-9441
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9493174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator