Active NPI
Mark D Everson, PHD
- Clinical Psychologist
- Chapel Hill, NC
National Provider Identifier
1275622508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1059
- Practice address
- 101 Manning Dr
Chapel Hill, NC 27599-0001 - Phone
- (919) 966-8596
- Fax
- (919) 843-5515
- NPI assigned
- Oct 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1059 | NC | Primary |
Addresses
Primary practice location
101 Manning Dr
Chapel Hill, NC 27599-0001
Mailing address
143 W Franklin St
Chapel Hill, NC 27516-2539
Phone (919) 966-8596
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6000220 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1059 | NC | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1275622508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "143 W FRANKLIN ST",
"city": "CHAPEL HILL",
"state": "NC",
"postal_code": "275162539",
"telephone_number": "919-966-8596",
"fax_number": "919-843-5515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 MANNING DR",
"city": "CHAPEL HILL",
"state": "NC",
"postal_code": "275990001",
"telephone_number": "919-966-8596",
"fax_number": "919-843-5515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVERSON",
"first_name": "MARK",
"middle_name": "D",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "1059",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6000220",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chapel Hill, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.