Provider Demographics
NPI:1508464520
Name:VERHALEN-EVANS, KRISTINE NICHOLE (APRN-FNP-C)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:NICHOLE
Last Name:VERHALEN-EVANS
Suffix:
Gender:F
Credentials:APRN-FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 KINGSMILL CIR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-5819
Mailing Address - Country:US
Mailing Address - Phone:903-312-3228
Mailing Address - Fax:
Practice Address - Street 1:1910 ROSELAND BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4246
Practice Address - Country:US
Practice Address - Phone:903-533-0644
Practice Address - Fax:903-533-0441
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1016672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX418173701Medicaid