Provider Demographics
NPI:1942769971
Name:EVERETT, MIKAYLA RENEE
Entity Type:Individual
Prefix:MISS
First Name:MIKAYLA
Middle Name:RENEE
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 1:2 WARWICK
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8949
Mailing Address - Country:US
Mailing Address - Phone:972-742-5381
Mailing Address - Fax:
Practice Address - Street 1:2 WARWICK
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-8949
Practice Address - Country:US
Practice Address - Phone:972-742-5381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant