Provider Demographics
NPI:1346554037
Name:EVERLY, ERICKA JAYLENE (CRNA)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:JAYLENE
Last Name:EVERLY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1231
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-1231
Mailing Address - Country:US
Mailing Address - Phone:406-262-1302
Mailing Address - Fax:406-265-1651
Practice Address - Street 1:30 13TH ST
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-5222
Practice Address - Country:US
Practice Address - Phone:406-262-1419
Practice Address - Fax:406-265-1651
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201998367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered