Provider Demographics
NPI:1528390598
Name:EVAN-HYMES, KRISTEN L (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:L
Last Name:EVAN-HYMES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 STUTZ DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8149
Mailing Address - Country:US
Mailing Address - Phone:330-729-9514
Mailing Address - Fax:330-729-9591
Practice Address - Street 1:3660 STUTZ DR STE 101
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8149
Practice Address - Country:US
Practice Address - Phone:330-729-9514
Practice Address - Fax:330-729-9591
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.010051207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0054213Medicaid
OHH009853OtherMEDICARE PTAN