Individual
JENNA LANE EVERETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
320 N MAIN, LOCKNEY, TX 79241
(806) 652-3373
(806) 652-2417
Mailing address
PO BOX 37, LOCKNEY, TX 79241-0037
(806) 652-3373
(806) 652-2417
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA10940
STATE LICENSE
TX
Enumeration date
10/25/2016
Last updated
06/28/2018
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