Provider Demographics
NPI:1023124492
Name:EVERITT, BEVERLY (APRN)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:
Last Name:EVERITT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 NORTH 104TH CIRCLE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8601 W DODGE RD
Practice Address - Street 2:SUITE 30
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3457
Practice Address - Country:US
Practice Address - Phone:402-354-8797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110565363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025175900Medicaid
NE10025175900Medicaid
P94837Medicare UPIN