Provider Demographics
NPI:1376584037
Name:ANDERSON, EVELYN KELLY (MD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:KELLY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 DOVE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5012
Mailing Address - Country:US
Mailing Address - Phone:704-283-8888
Mailing Address - Fax:704-283-5747
Practice Address - Street 1:1301 DOVE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5012
Practice Address - Country:US
Practice Address - Phone:704-283-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
6594700OtherCIGNA
NC017WAOtherBCBSNC
NC5903343Medicaid
2217509BMedicare PIN
NCG15996Medicare UPIN