Provider Demographics
NPI:1447770722
Name:EVANS, KENISHA JEAN (MD)
Entity Type:Individual
Prefix:
First Name:KENISHA
Middle Name:JEAN
Last Name:EVANS
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 1:1540 ALEXANDRA LN
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3656
Mailing Address - Country:US
Mailing Address - Phone:717-798-3363
Mailing Address - Fax:717-798-3364
Practice Address - Street 1:1540 ALEXANDRA LN
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3656
Practice Address - Country:US
Practice Address - Phone:717-798-3363
Practice Address - Fax:717-798-3364
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD475355207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty