Provider Demographics
NPI:1245583368
Name:KENNEDY-EVANS, KAREN LOU (RN, FNP, APRN-BC)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LOU
Last Name:KENNEDY-EVANS
Suffix:
Gender:F
Credentials:RN, FNP, APRN-BC
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:LOU
Other - Last Name:LAUDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5090 N CORTE DE CATALONIA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6078
Mailing Address - Country:US
Mailing Address - Phone:520-232-1019
Mailing Address - Fax:520-299-1680
Practice Address - Street 1:5090 N CORTE DE CATALONIA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6078
Practice Address - Country:US
Practice Address - Phone:520-232-1019
Practice Address - Fax:520-299-1680
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0176318363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN871120Medicaid
IN871120Medicaid