Individual
SUMMER EVERETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4055 GATWICK CT APT 1008, FORT WORTH, TX 76155-2854
(817) 262-7175
Mailing address
4055 GATWICK CT APT 1008, FORT WORTH, TX 76155-2854
(817) 262-7175
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TEXAS
BLUE CROSS BLUE SHEILD
TX
05
—
TEXAS
—
TX
Enumeration date
01/30/2017
Last updated
01/30/2017
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