Individual
JENELLE K EVERNHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2211 MAYFAIR DR STE 101, OWENSBORO, KY 42301-4569
(270) 688-1352
(270) 683-4313
Mailing address
PO BOX 23229, OWENSBORO, KY 42304-3229
(270) 688-1330
(270) 688-1338
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10001008A
IN
363A00000X
Physician Assistant
Primary
PA1009
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300004679
—
IN
05
—
7100100710
—
KY
Enumeration date
05/06/2008
Last updated
04/11/2018
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