Provider Demographics
NPI:1730181090
Name:EVERMAN, KELLY R (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:R
Last Name:EVERMAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1800 CHURCH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2208
Mailing Address - Country:US
Mailing Address - Phone:615-329-3624
Mailing Address - Fax:615-329-0639
Practice Address - Street 1:1800 CHURCH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2208
Practice Address - Country:US
Practice Address - Phone:615-329-3624
Practice Address - Fax:615-329-0639
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2017-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD48847207W00000X, 207WX0200X, 207W00000X, 207WX0200X
KY38136207WX0200X, 207WX0200X
OH35.082871174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1529953Medicaid
KY64071517Medicaid
TN1529953Medicaid