Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | FE2803333 | KS |
N | 208000000X | Pediatrician | 54099 | MN |
NPI | 1093036832 |
---|---|
Provider Name | Brynn E Everist |
First Address | Overland Park, KS 66210-1863 |
Second Address | Overland Park, KS 66210-1863 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2010 |
Last Update Date | 05/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | MN |