Provider Demographics
NPI:1326663394
Name:EVOLVE HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:EVOLVE HEALTH & WELLNESS LLC
Other - Org Name:EVOLVE DIABETES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LOYD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:316-768-1900
Mailing Address - Street 1:6805 W NORTHWIND CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-2583
Mailing Address - Country:US
Mailing Address - Phone:316-768-1900
Mailing Address - Fax:
Practice Address - Street 1:2118 N TYLER RD
Practice Address - Street 2:BLDG B, STE 101
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4912
Practice Address - Country:US
Practice Address - Phone:316-768-1900
Practice Address - Fax:949-862-3769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty