Provider Demographics
NPI:1932818622
Name:EVERETTE, JANA KATHLEEN
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:KATHLEEN
Last Name:EVERETTE
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 1:430 WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-1470
Mailing Address - Country:US
Mailing Address - Phone:270-564-0250
Mailing Address - Fax:
Practice Address - Street 1:430 WOOD AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-1470
Practice Address - Country:US
Practice Address - Phone:270-564-0250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program