Provider Demographics
NPI:1467457556
Name:EVANS, KATHERINE ABRAHAM (NP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ABRAHAM
Last Name:EVANS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 COUNCIL BLUFF DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-4139
Mailing Address - Country:US
Mailing Address - Phone:404-327-7688
Mailing Address - Fax:
Practice Address - Street 1:1713 COUNCIL BLUFF DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-4139
Practice Address - Country:US
Practice Address - Phone:404-327-7688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA157007363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA892313246AMedicaid
GA892313246BMedicaid
GA892313246AMedicaid
Q26026Medicare UPIN