Provider Demographics
NPI:1467922385
Name:EVERETTS, MINDY RAE (QBHP)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:RAE
Last Name:EVERETTS
Suffix:
Gender:F
Credentials:QBHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-5930
Mailing Address - Country:US
Mailing Address - Phone:501-305-3305
Mailing Address - Fax:501-279-0760
Practice Address - Street 1:1507 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4661
Practice Address - Country:US
Practice Address - Phone:501-305-2359
Practice Address - Fax:501-305-2348
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR222Q00000XMedicaid