Samuel R Everett, PA-C

Primary specialty

Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0808X

License

9492493-1206 Issued in UT

Practice address

154 E Myrtle Ave Ste 204
Murray, UT 84107-4850

Phone

(801) 369-8989

Fax

(801) 704-9741

NPI assigned

Dec 11, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Mallory Danielson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Odyssey House Inc

  • Family Medicine Physician
  • Salt Lake City, UT
  • NPI 1407481245
  NPD
• Mayrx

  • Family Medicine Physician
  • Asheville, NC
  • NPI 1255039897
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1418256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1104224815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "154 E MYRTLE AVE STE 204",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841074850",
            "telephone_number": "801-369-8989",
            "fax_number": "801-704-9741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 E MYRTLE AVE STE 204",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841074850",
            "telephone_number": "801-369-8989",
            "fax_number": "801-704-9741"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "710 E 200 S Apt 3B",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841022253",
            "country_code": "US",
            "telephone_number": "385-376-3739",
            "fax_number": "385-360-9959",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "140 W 2100 S Ste 110",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841151855",
            "country_code": "US",
            "telephone_number": "385-376-3739",
            "fax_number": "385-360-3739",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EVERETT",
        "first_name": "SAMUEL",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-12-11",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "UT",
            "license": "9492493-1206",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "9492493-1206",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "DANIELSON",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kristina Evans
• Laurie Evans
• Lynette Erika Evans, N.P.
• Brenda Everett, PHARM.D.
• Michael Steven Everett, L-ATC
• Sarah Christine Everett, PA-C
• Evergreen Hospice LLC
• Evergreen Technical Services Inc
• Lisa Everhart, MS,RD,CSSD
• Excell Medical Center, Inc.

• Psychiatric/Mental Health Clinical Nurse Specialist in Murray, UT
• Providers in Murray, UT by specialty
• Psychiatric/Mental Health Clinical Nurse Specialist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.