Provider Demographics
NPI:1346919990
Name:EVANS, KRISTEN GRACE
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:GRACE
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SUGAR CAMP BRANCH
Mailing Address - Street 2:
Mailing Address - City:LENORE
Mailing Address - State:WV
Mailing Address - Zip Code:25676
Mailing Address - Country:US
Mailing Address - Phone:304-475-4703
Mailing Address - Fax:
Practice Address - Street 1:140 SUGAR CAMP BRANCH
Practice Address - Street 2:
Practice Address - City:LENORE
Practice Address - State:WV
Practice Address - Zip Code:25676
Practice Address - Country:US
Practice Address - Phone:304-475-4703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant