TABETHA LYNN EVERNDEN


Address: 155 S Empire Blvd, Coos Bay, OR 97420-3374
Phone: 5417563111

TABETHA LYNN EVERNDEN (NPI# 1215550934) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1215550934
Entity Type Individual
Full Name TABETHA LYNN EVERNDEN
Credential CRM
Practice Address 155 S Empire Blvd
Coos Bay
OR 97420-3374
Mailing Address 1942 Sheridan Ave
North Bend
OR 97459-3416
Practice Telephone 5417563111
Practice Fax Number 5417562111
Mailing Telephone 5417563111
Mailing Fax Number 5417562111
Enumeration Date 2020-05-28
Last Update Date 2020-05-28
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 175T00000X Peer Specialist 20-CRM-114 OR Other Service Providers

Provider Secondary Practice Location

Address Telephone Number Fax Number
1741 Newmark Ave, Coos Bay, OR 974204704 5417563111 5417562111

Office Location

Street Address 155 S EMPIRE BLVD
City COOS BAY
State OR
Zip Code 97420-3374

Providers in the same location

NPI Name Taxonomy Address Enumeration
1467856922 Carolyn Louise Billman Counselor 155 S Empire Blvd, Coos Bay, OR 97420-3374 2014-10-13
1154944346 Andrea Gross Peer Specialist 155 S Empire Blvd, Coos Bay, OR 97420-3374 2020-05-21
1013536986 William Todd Stone Peer Specialist 155 S Empire Blvd, Coos Bay, OR 97420-3374 2020-04-10
1003445875 Sarah Susan Tucker Peer Specialist 155 S Empire Blvd, Coos Bay, OR 97420-3374 2020-04-03
1376174003 Joshua Jay Haynes Peer Specialist 155 S Empire Blvd, Coos Bay, OR 97420-3374 2020-01-31
1730743535 Paul Gonzales Peer Specialist 155 S Empire Blvd, Coos Bay, OR 97420-3374 2019-04-26
1396201216 Anthony L Wilson Peer Specialist 155 S Empire Blvd, Coos Bay, OR 97420-3374 2019-02-15
1245795095 Diana Julianne Collins Peer Specialist 155 S Empire Blvd, Coos Bay, OR 97420-3374 2019-02-06
1144785064 Ronni Waltz Peer Specialist 155 S Empire Blvd, Coos Bay, OR 97420 2019-02-05
1114499324 Tasha Anne Walter Counselor 155 S Empire Blvd, Coos Bay, OR 97420-3374 2018-12-28
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1346880606 Danielle Goette Massage Therapist 320 Central Ave Suite 226, Coos Bay, OR 97420 2020-01-14
1730643735 Nicole Hand-therapeutic Massage Massage Therapist 3229 Broadway Avenue, Suite D, Coos Bay, OR 97420 2019-01-24
1528531100 A Better Reality Clinic/Center 2690 N. 17th Sstreet, Coos Bay, OR 97420 2019-01-07
1396216883 Elizabeth Rose Stephens Health Educator 97381 Newport Lane, Coos Bay, OR 97420 2018-12-10
1093263386 Megan Smith Physician Assistant 375 Park Ave Ste 5, Coos Bay, OR 97420 2016-09-14
1285091884 Richard T Rigney Counselor 62754 Karl Road, Coos Bay, OR 97420 2016-01-27
1821493032 James Thomas Agee Pharmacist 2051 Newmark Avenue, Walmart Pharmacy 1880, Coos Bay, OR 97420 2014-10-30
1346663895 Steven D. Richardson D.m.d. L.l.c Dentist 1835 Ocean Blvd Se, Coos Bay, OR 97420 2014-02-03
1144669243 Michael Jason Cole Pharmacist 1020 South First Ave, Coos Bay, OR 97420 2013-06-21
1639518053 Jonathan Thomas Small Physical Therapist 2645 North 17th St, Coos Bay, OR 97420 2013-06-19
Find all providers in zip 97420

Taxonomy Information

Taxonomy Code 175T00000X
Grouping Other Service Providers
Classification Peer Specialist

Taxonomy Definition

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
Notes: Source: National Uniform Claim Committee [7/1/2014: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1154944346 Andrea Gross Peer Specialist 155 S Empire Blvd, Coos Bay, OR 97420-3374 2020-05-21
1013536986 William Todd Stone Peer Specialist 155 S Empire Blvd, Coos Bay, OR 97420-3374 2020-04-10
1003445875 Sarah Susan Tucker Peer Specialist 155 S Empire Blvd, Coos Bay, OR 97420-3374 2020-04-03
1881229797 Kelli Woods Peer Specialist 2020 Thompson Rd, Coos Bay, OR 97420-2041 2020-03-11
1477188399 Dorannlyn Mills Peer Specialist 2020 Thompson Rd, Coos Bay, OR 97420-2041 2020-03-11
1376174003 Joshua Jay Haynes Peer Specialist 155 S Empire Blvd, Coos Bay, OR 97420-3374 2020-01-31
1114560802 Jesse C Staubach Peer Specialist 320 Central Ave Ste 304, Coos Bay, OR 97420-2241 2019-10-24
1730743535 Paul Gonzales Peer Specialist 155 S Empire Blvd, Coos Bay, OR 97420-3374 2019-04-26
1396201216 Anthony L Wilson Peer Specialist 155 S Empire Blvd, Coos Bay, OR 97420-3374 2019-02-15
1225593668 Riley Kirby Peer Specialist 2020 Thompson Rd, Coos Bay, OR 97420-2041 2019-02-08
Find all providers in COOS BAY

Competitor

Search similar providers

City COOS BAY
Zip Code 97420

Improve Information

Please comment or provide details below to improve the information on TABETHA LYNN EVERNDEN.

Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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