Provider Demographics
NPI:1477241149
Name:EVERETT, TAKEYLA SHENAY (CEO, LPN)
Entity Type:Individual
Prefix:MS
First Name:TAKEYLA
Middle Name:SHENAY
Last Name:EVERETT
Suffix:
Gender:F
Credentials:CEO, LPN
Other - Prefix:MRS
Other - First Name:TAKEYLA
Other - Middle Name:SHENA
Other - Last Name:EVERETT-PRESLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12107 GREYWOLF LN
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-9018
Mailing Address - Country:US
Mailing Address - Phone:678-697-8198
Mailing Address - Fax:
Practice Address - Street 1:12107 GREYWOLF LN
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-9018
Practice Address - Country:US
Practice Address - Phone:678-697-8198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN068832164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse