Provider Demographics
NPI:1417573932
Name:NANYAMA, EVALYNE
Entity Type:Individual
Prefix:
First Name:EVALYNE
Middle Name:
Last Name:NANYAMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVALYNE
Other - Middle Name:NANYAMA
Other - Last Name:EKESA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:211 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5049
Practice Address - Country:US
Practice Address - Phone:573-331-5980
Practice Address - Fax:573-331-5044
Is Sole Proprietor?:No
Enumeration Date:2020-06-20
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022043441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional