Provider Demographics
NPI:1720872104
Name:EVERETT, TERRY LEVON
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:LEVON
Last Name:EVERETT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-5024
Mailing Address - Country:US
Mailing Address - Phone:804-828-0733
Mailing Address - Fax:804-828-8300
Practice Address - Street 1:417 N 11TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5024
Practice Address - Country:US
Practice Address - Phone:804-828-0733
Practice Address - Fax:804-828-8300
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207L00000X207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology