Provider Demographics
NPI:1497233324
Name:EVANS, KIMBERLY S (CST/CSFA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:EVANS
Suffix:
Gender:F
Credentials:CST/CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7016 OAK COVE DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-5013
Mailing Address - Country:US
Mailing Address - Phone:228-243-8471
Mailing Address - Fax:
Practice Address - Street 1:7016 OAK COVE DR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-5013
Practice Address - Country:US
Practice Address - Phone:228-243-8471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant