Provider Demographics
NPI:1407518319
Name:EVANS, KATHERINE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
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 1:2635 SEAGLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:VALE
Mailing Address - State:NC
Mailing Address - Zip Code:28168-7780
Mailing Address - Country:US
Mailing Address - Phone:828-358-7453
Mailing Address - Fax:
Practice Address - Street 1:2635 SEAGLETOWN RD
Practice Address - Street 2:
Practice Address - City:VALE
Practice Address - State:NC
Practice Address - Zip Code:28168-7780
Practice Address - Country:US
Practice Address - Phone:828-358-7453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261890363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner