Provider Demographics
NPI:1326313974
Name:EVERLY, DIANA MICHELLE
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MICHELLE
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 1:816 N MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2915
Mailing Address - Country:US
Mailing Address - Phone:870-204-6191
Mailing Address - Fax:
Practice Address - Street 1:816 N MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2915
Practice Address - Country:US
Practice Address - Phone:870-204-6191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist