Basic Information
| Provider Information | |||||||||
| NPI: | 1952742942 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVERALL | ||||||||
| FirstName: | ULYESSE | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1624 MAIN STREET AGAPE SENIOR PRIMARY CARE, INC., | ||||||||
| Address2: | DBA AGAPE PHYSICIANS CARE | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034540365 | ||||||||
| FaxNumber: | 8034046000 | ||||||||
| Practice Location | |||||||||
| Address1: | 1317 EBENEZER RD | ||||||||
| Address2: | AGAPE PHYSICIANS CARE | ||||||||
| City: | ROCK HILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297322336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032078200 | ||||||||
| FaxNumber: | 8032078130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2013 | ||||||||
| LastUpdateDate: | 09/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APRN18357 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.