William W Everly Jr., CARE PROVIDER

Primary specialty

Home Health AideTaxonomy code 374U00000X

License

002919919 Issued in CA

Practice address

30051 Swan Point Dr
Canyon Lake, CA 92587-7407

Phone

(949) 212-8851

Fax

(949) 481-3197

NPI assigned

Feb 10, 2023

Last updated

Feb 10, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1675987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675987200000",
    "number": "1659078582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30051 SWAN POINT DR",
            "city": "CANYON LAKE",
            "state": "CA",
            "postal_code": "925877407",
            "telephone_number": "949-212-8851",
            "fax_number": "949-481-3197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30051 SWAN POINT DR",
            "city": "CANYON LAKE",
            "state": "CA",
            "postal_code": "925877407",
            "telephone_number": "949-212-8851",
            "fax_number": "949-481-3197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVERLY",
        "first_name": "WILLIAM",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "CARE PROVIDER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-02-10",
        "last_updated": "2023-02-10",
        "certification_date": "2023-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "CA",
            "license": "002919919",
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "CA",
            "license": "002919919",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002919919",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dawn Chatigny, LAC
• Lorna Lyanthie Conyers, PHD
• Mary Lucinda Demoss, OD
• Alex Denes, MD
• Heather Depriest
• Tavia I Fontenot
• Hannah E Fraley, PHD, APRN, PMHNP-BC
• Taylor Christy Frasca
• Frozen in Time Cryo Therapy Center
• Ashlyn Gayk

• Home Health Aide in Canyon Lake, CA
• Providers in Canyon Lake, CA by specialty
• Home Health Aide in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.