Provider Demographics
NPI:1225222490
Name:EVELER, KENDRA NICOLE (PA)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:NICOLE
Last Name:EVELER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 FREEDOM WAY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402
Mailing Address - Country:US
Mailing Address - Phone:717-741-9914
Mailing Address - Fax:717-741-9917
Practice Address - Street 1:2350 FREEDOM WAY
Practice Address - Street 2:SUITE 107
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402
Practice Address - Country:US
Practice Address - Phone:717-741-9914
Practice Address - Fax:717-741-9917
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054754363A00000X
VA0110002578363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001866305004Medicaid
PAC04290Medicare UPIN
PA001866305004Medicaid