Provider Demographics
NPI:1609060235
Name:EVERLEY, KEARA DAWN
Entity Type:Individual
Prefix:
First Name:KEARA
Middle Name:DAWN
Last Name:EVERLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KEARA
Other - Middle Name:DAWN
Other - Last Name:BURDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:524 MACRANDER DR
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-8311
Mailing Address - Country:US
Mailing Address - Phone:859-626-2109
Mailing Address - Fax:
Practice Address - Street 1:524 MACRANDER DR
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-8311
Practice Address - Country:US
Practice Address - Phone:859-626-2109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist