Provider Demographics
NPI:1225624711
Name:EVERMAN, JESSICA MICHELLE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MICHELLE
Last Name:EVERMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2836 S JIOVANNI PL
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7945
Mailing Address - Country:US
Mailing Address - Phone:801-664-1013
Mailing Address - Fax:
Practice Address - Street 1:1660 S WOODSAGE AVE BLDG A
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7670
Practice Address - Country:US
Practice Address - Phone:801-664-1013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDF12200061363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily