Jenelle K Evernham, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA1009 Issued in KY

Practice address

2211 Mayfair Dr Ste 101
Owensboro, KY 42301-4569

Phone

(270) 688-1352

Fax

(270) 683-4313

NPI assigned

May 6, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Jenelle K Carter Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Owensboro Health Medical Group, Inc

  • Family Medicine Physician
  • Owensboro, KY
  • NPI 1376594242

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1210032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523404800000",
    "number": "1932375391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23229",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423043229",
            "telephone_number": "270-688-1330",
            "fax_number": "270-688-1338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 MAYFAIR DR STE 101",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423014569",
            "telephone_number": "270-688-1352",
            "fax_number": "270-683-4313"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27 US Highway 66 E",
            "address_purpose": "LOCATION",
            "city": "Tell City",
            "state": "IN",
            "postal_code": "475862044",
            "country_code": "US",
            "telephone_number": "812-395-2011",
            "fax_number": "812-395-2012",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "811 E Parrish Ave",
            "address_purpose": "LOCATION",
            "city": "Owensboro",
            "state": "KY",
            "postal_code": "423033258",
            "country_code": "US",
            "telephone_number": "270-688-5310",
            "fax_number": "270-691-8049",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 Mary St",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477470001",
            "country_code": "US",
            "telephone_number": "812-450-6815",
            "fax_number": "812-450-6822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EVERNHAM",
        "first_name": "JENELLE",
        "middle_name": "K",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-06",
        "last_updated": "2018-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10001008A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA1009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100100710",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300004679",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENELLE",
            "last_name": "CARTER",
            "middle_name": "K",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Carey Renea Evans, CST, KCSA
• Charles Ted Evans, MSED, ATC, LAT
• Julian J Evans, CADC
• Sarah Rae Evans, CSW
• Ashley Everly
• Katherine Eversole, LCSW
• Joyce Evitts, LCSW
• Evolution Primary Care
• Donna Kay Ewing
• Jennifer Ewing, M.ED., LPCA

• Physician Assistant in Owensboro, KY
• Providers in Owensboro, KY by specialty
• Physician Assistant in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2018; 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.