Provider Demographics
NPI:1578198016
Name:EVERETT, KIERI LEIGH
Entity Type:Individual
Prefix:
First Name:KIERI
Middle Name:LEIGH
Last Name:EVERETT
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 1:10455 ORTHOPAEDIC DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-7955
Mailing Address - Country:US
Mailing Address - Phone:812-858-2100
Mailing Address - Fax:
Practice Address - Street 1:10455 ORTHOPAEDIC DR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-7955
Practice Address - Country:US
Practice Address - Phone:812-858-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant