Provider Demographics
NPI:1992777304
Name:EVERT, KIM A (CRNA)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:A
Last Name:EVERT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:12222 MERIT DR STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-3294
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP111085367500000X
TX500207367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8872UGOtherBCBS
TX154320908Medicaid
TX154320909Medicaid
TXP01445787OtherRR
TX154320907Medicaid
TX85197UOtherBLUE CROSS
TX89606UOtherBCBS
TXP00983532OtherRAILROAD
TXTXB136176Medicare PIN
TX154320904Medicare PIN
TX89606UOtherBCBS
TX8872UGOtherBCBS
TX8L5263Medicare PIN