Provider Demographics
NPI:1235720376
Name:EVANS, KELLY SUE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:SUE
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 1:2204 NORTH SECTION STREET
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882
Mailing Address - Country:US
Mailing Address - Phone:812-268-2556
Mailing Address - Fax:
Practice Address - Street 1:2204 NORTH SECTION STREET
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882
Practice Address - Country:US
Practice Address - Phone:812-268-2556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010738A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner