Provider Demographics
NPI:1407397573
Name:EVERETT, DEBORAH (AGNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:EVERETT
Suffix:
Gender:F
Credentials:AGNP
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 130
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NC
Mailing Address - Zip Code:27840-0130
Mailing Address - Country:US
Mailing Address - Phone:252-661-1623
Mailing Address - Fax:
Practice Address - Street 1:1130 GODWIN DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-6828
Practice Address - Country:US
Practice Address - Phone:252-789-0401
Practice Address - Fax:252-789-0452
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC127594363LG0600X, 363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology