Provider Demographics
NPI:1477955995
Name:EVINS, KALENDER DORSHELL (FN,P)
Entity Type:Individual
Prefix:
First Name:KALENDER
Middle Name:DORSHELL
Last Name:EVINS
Suffix:
Gender:F
Credentials:FN,P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 RIDGE LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9427
Mailing Address - Country:US
Mailing Address - Phone:901-765-4100
Mailing Address - Fax:
Practice Address - Street 1:2747 BARTLETT BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-4580
Practice Address - Country:US
Practice Address - Phone:901-590-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ008641Medicaid