Provider Demographics
NPI:1497305171
Name:EVANS, KENITHIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:KENITHIA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6966 CHESSGATE FALLS LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-1818
Mailing Address - Country:US
Mailing Address - Phone:832-484-2066
Mailing Address - Fax:
Practice Address - Street 1:6966 CHESSGATE FALLS LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-1818
Practice Address - Country:US
Practice Address - Phone:832-484-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX811000163WG0000X, 163WM0102X, 163WP1700X, 163WX0003X, 163W00000X
171M00000X, 171W00000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WP1700XNursing Service ProvidersRegistered NursePerinatal
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor
No174H00000XOther Service ProvidersHealth Educator