Provider Demographics
NPI:1427587088
Name:NEVETT, DEQUARUS TERRELL (CRANIAL PROSTHESIS)
Entity Type:Individual
Prefix:MR
First Name:DEQUARUS
Middle Name:TERRELL
Last Name:NEVETT
Suffix:
Gender:M
Credentials:CRANIAL PROSTHESIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407-32 FAIRFAX DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35064
Mailing Address - Country:US
Mailing Address - Phone:205-520-6922
Mailing Address - Fax:
Practice Address - Street 1:407 FAIRFAX DR APT 32
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:AL
Practice Address - Zip Code:35064-1063
Practice Address - Country:US
Practice Address - Phone:205-520-6922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1744G0900X
AL1251721744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No1744G0900XOther Service ProvidersSpecialistGraphics Designer