Provider Demographics
NPI:1730800046
Name:EVEXIA, LLC
Entity type:Organization
Organization Name:EVEXIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-419-1968
Mailing Address - Street 1:7112 DARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-7013
Mailing Address - Country:US
Mailing Address - Phone:410-419-1968
Mailing Address - Fax:
Practice Address - Street 1:7112 DARLINGTON DR
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-7013
Practice Address - Country:US
Practice Address - Phone:410-419-1968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty