Provider Demographics
NPI:1376548123
Name:EVANS-DEBEVERLY, ARLENE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:
Last Name:EVANS-DEBEVERLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-0667
Mailing Address - Country:US
Mailing Address - Phone:316-685-1206
Mailing Address - Fax:316-688-5208
Practice Address - Street 1:9300 E 29TH ST N
Practice Address - Street 2:STE 201
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2183
Practice Address - Country:US
Practice Address - Phone:316-685-1277
Practice Address - Fax:316-688-5208
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100344260BMedicaid
KS042056Medicare PIN