Provider Demographics
NPI:1487968277
Name:EVERETT, KARA NICOLE (DPT)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:NICOLE
Last Name:EVERETT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-0128
Mailing Address - Country:US
Mailing Address - Phone:804-435-3435
Mailing Address - Fax:804-435-3682
Practice Address - Street 1:500 IRVINGTON ROAD
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482
Practice Address - Country:US
Practice Address - Phone:804-435-3435
Practice Address - Fax:804-435-3682
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206576225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist