Provider Demographics
NPI:1598294928
Name:EVERETT, JESSICA K (RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:K
Last Name:EVERETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HACKBERRY DR
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:DE
Mailing Address - Zip Code:19943-6111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 HACKBERRY DRIVE
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:DE
Practice Address - Zip Code:19943
Practice Address - Country:US
Practice Address - Phone:302-222-4577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELI-0048000163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DELI-0048000OtherSTATE OF DELAWARE