Provider Demographics
NPI:1750070009
Name:EVERSON, JACQUELYN STRONG (ACNP)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:STRONG
Last Name:EVERSON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15891 SILVERHILL AVE
Mailing Address - Street 2:
Mailing Address - City:SILVERHILL
Mailing Address - State:AL
Mailing Address - Zip Code:36576-3877
Mailing Address - Country:US
Mailing Address - Phone:850-934-5713
Mailing Address - Fax:
Practice Address - Street 1:15891 SILVERHILL AVE
Practice Address - Street 2:
Practice Address - City:SILVERHILL
Practice Address - State:AL
Practice Address - Zip Code:36576-3877
Practice Address - Country:US
Practice Address - Phone:850-934-5713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-142951363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care