Provider Demographics
NPI:1801059464
Name:EVERMAN, NICOLE ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANNE
Last Name:EVERMAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:ANNE
Other - Last Name:YARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7818
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:3470 BLAZER PKWY STE 150
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1078
Practice Address - Country:US
Practice Address - Phone:859-263-8807
Practice Address - Fax:859-263-8808
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR13792084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100120080Medicaid
KYK148880Medicare PIN