Provider Demographics
NPI:1205419058
Name:KIGHT, EVELYN STEPHANIE (RDH)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:STEPHANIE
Last Name:KIGHT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 TJ KING RD
Mailing Address - Street 2:
Mailing Address - City:LOCKESBURG
Mailing Address - State:AR
Mailing Address - Zip Code:71846-9692
Mailing Address - Country:US
Mailing Address - Phone:870-784-4886
Mailing Address - Fax:
Practice Address - Street 1:204 MCCARTNEY BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3018
Practice Address - Country:US
Practice Address - Phone:903-793-6976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22433124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty