Provider Demographics
NPI:1962177147
Name:EVERETT, JENNIFER RENEE (CPNP-PC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENEE
Last Name:EVERETT
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 CHARLES HARDY PKWY STE 122
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-9470
Mailing Address - Country:US
Mailing Address - Phone:770-505-3162
Mailing Address - Fax:
Practice Address - Street 1:2713 CHARLES HARDY PKWY STE 122
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-9470
Practice Address - Country:US
Practice Address - Phone:770-505-3162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN230896363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics