Provider Demographics
NPI:1427599117
Name:EVERSOLE, EMILY MARIE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:EVERSOLE
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 1:343 WALLER AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2912
Mailing Address - Country:US
Mailing Address - Phone:589-271-9448
Mailing Address - Fax:
Practice Address - Street 1:343 WALLER AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2912
Practice Address - Country:US
Practice Address - Phone:589-271-9448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator