Provider Demographics
NPI:1477958361
Name:EVANS, KATHLEEN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 NE LOOP 410 STE 850
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5824
Mailing Address - Country:US
Mailing Address - Phone:210-805-9800
Mailing Address - Fax:210-207-4922
Practice Address - Street 1:332 W SUNSET RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1767
Practice Address - Country:US
Practice Address - Phone:210-546-1430
Practice Address - Fax:210-546-1439
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily