Provider Demographics
NPI:1306052873
Name:EVERLY, DONNA CAROL (MAE, DI)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:CAROL
Last Name:EVERLY
Suffix:
Gender:F
Credentials:MAE, DI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 SUWANNEE TRAIL STREET
Mailing Address - Street 2:BOWLING GREEN, KY
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7956
Mailing Address - Country:US
Mailing Address - Phone:270-901-5749
Mailing Address - Fax:270-746-0729
Practice Address - Street 1:380 SUWANNEE TRAIL ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7956
Practice Address - Country:US
Practice Address - Phone:270-901-5749
Practice Address - Fax:270-746-0729
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200180931222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01526OtherFIRST STEPS PROVIDER NUMB