Provider Demographics
NPI:1235151242
Name:EVERETTE, RACHEL MARIE (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:EVERETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 W GAUTHIER RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-7170
Mailing Address - Country:US
Mailing Address - Phone:337-480-7050
Mailing Address - Fax:337-480-7051
Practice Address - Street 1:1900 W GAUTHIER RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-7170
Practice Address - Country:US
Practice Address - Phone:337-480-7050
Practice Address - Fax:337-480-7051
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012813902080N0001X
LA0224352080N0001X
OK254192080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX205473705Medicaid
AR165492001Medicaid
LA1654663Medicaid
KS200461160AMedicaid
OK200106210AMedicaid
AR165492001Medicaid
AR165492001Medicaid