Provider Demographics
NPI:1407573009
Name:EVERETTS, COURTNEY DIANE (NP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DIANE
Last Name:EVERETTS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 CROWN POINT PL
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-6658
Mailing Address - Country:US
Mailing Address - Phone:256-656-3128
Mailing Address - Fax:
Practice Address - Street 1:1340 NW BROAD ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1755
Practice Address - Country:US
Practice Address - Phone:615-439-6165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32260363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN32260Medicaid