Provider Demographics
NPI:1205034253
Name:EVANS, KATHLEEN URIG (MSN, APRN, CS-P)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:URIG
Last Name:EVANS
Suffix:
Gender:F
Credentials:MSN, APRN, CS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 EASTERN AVE
Mailing Address - Street 2:MASON LORD BLDG, D2 EAST
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2735
Mailing Address - Country:US
Mailing Address - Phone:410-550-0022
Mailing Address - Fax:410-550-1748
Practice Address - Street 1:4940 EASTERN AVE
Practice Address - Street 2:MASON LORD BLDG, D2 EAST
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2735
Practice Address - Country:US
Practice Address - Phone:410-550-0022
Practice Address - Fax:410-550-1748
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR087566364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health