Provider Demographics
NPI:1104589092
Name:EVERETT, KENRICK (DPP COACH)
Entity type:Individual
Prefix:MR
First Name:KENRICK
Middle Name:
Last Name:EVERETT
Suffix:
Gender:M
Credentials:DPP COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E 42ND ST FL 13
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5773
Mailing Address - Country:US
Mailing Address - Phone:917-749-0199
Mailing Address - Fax:
Practice Address - Street 1:205 E 42ND ST FL 13
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5773
Practice Address - Country:US
Practice Address - Phone:917-749-0199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator