Provider Demographics
NPI:1326253774
Name:EVERTS, SHELLEY JANE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:JANE
Last Name:EVERTS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 PEE DEE AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-4932
Mailing Address - Country:US
Mailing Address - Phone:704-986-1500
Mailing Address - Fax:704-983-3919
Practice Address - Street 1:350 PEE DEE AVE
Practice Address - Street 2:STE 101
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-4932
Practice Address - Country:US
Practice Address - Phone:704-986-1500
Practice Address - Fax:704-983-3919
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC005002801207Q00000X
NC5002801363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
2592950OtherMEDICARE PTAN
NC186Q2OtherBCBS
NC2592950AOtherMEDICARE PTAN