Provider Demographics
NPI:1861115131
Name:COATS, EVERLEY BROOKE (FNP-BC)
Entity type:Individual
Prefix:
First Name:EVERLEY
Middle Name:BROOKE
Last Name:COATS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 COUNTY ROAD 8051
Mailing Address - Street 2:
Mailing Address - City:RIENZI
Mailing Address - State:MS
Mailing Address - Zip Code:38865-9357
Mailing Address - Country:US
Mailing Address - Phone:662-720-6176
Mailing Address - Fax:
Practice Address - Street 1:13 COUNTY ROAD 8051
Practice Address - Street 2:
Practice Address - City:RIENZI
Practice Address - State:MS
Practice Address - Zip Code:38865-9357
Practice Address - Country:US
Practice Address - Phone:662-720-6176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily