Provider Demographics
NPI:1699821496
Name:EVERSON, KERRI NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KERRI
Middle Name:NICOLE
Last Name:EVERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6858 AVENSONG LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1262
Mailing Address - Country:US
Mailing Address - Phone:865-558-3199
Mailing Address - Fax:
Practice Address - Street 1:820 N KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-2635
Practice Address - Country:US
Practice Address - Phone:865-717-3586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8426122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist