Provider Demographics
NPI:1073596466
Name:EVANS, KIM HOUSER (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:HOUSER
Last Name:EVANS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5212
Mailing Address - Country:US
Mailing Address - Phone:828-514-1173
Mailing Address - Fax:
Practice Address - Street 1:1830 5TH ST NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5212
Practice Address - Country:US
Practice Address - Phone:828-514-1173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201208363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592191Medicare ID - Type Unspecified
NCQ26251Medicare UPIN