Provider Demographics
NPI:1609839711
Name:EVERETT, WILLIAM (PA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:EVERETT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 ANTILLEY RD
Mailing Address - Street 2:STE. 270
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5267
Mailing Address - Country:US
Mailing Address - Phone:325-437-5555
Mailing Address - Fax:
Practice Address - Street 1:1680 ANTILLEY RD
Practice Address - Street 2:STE. 270
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5267
Practice Address - Country:US
Practice Address - Phone:325-437-5555
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02617363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D3529Medicare ID - Type Unspecified