Provider Demographics
NPI:1124696927
Name:EVERETT, CHRISTA (RN)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:EVERETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:
Other - Last Name:GOSHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12204 CREEK BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-5059
Mailing Address - Country:US
Mailing Address - Phone:513-479-9524
Mailing Address - Fax:
Practice Address - Street 1:12204 CREEK BRIDGE LN
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-5059
Practice Address - Country:US
Practice Address - Phone:513-479-9524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN219170163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse