Provider Demographics
NPI:1285129460
Name:EVERETT, LOTTIE MARIE (MSN APRN FNP-C)
Entity type:Individual
Prefix:MISS
First Name:LOTTIE
Middle Name:MARIE
Last Name:EVERETT
Suffix:
Gender:F
Credentials:MSN APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6033 SANDHURST LN APT A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-4719
Mailing Address - Country:US
Mailing Address - Phone:817-823-8057
Mailing Address - Fax:
Practice Address - Street 1:1925 E BELT LINE RD STE 208
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-5826
Practice Address - Country:US
Practice Address - Phone:972-666-9200
Practice Address - Fax:469-900-8090
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285129460OtherNPI