Provider Demographics
NPI:1619592730
Name:EVANS, KELSEY MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:MICHELLE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 W UNDERWOOD ST FL 3
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1122
Mailing Address - Country:US
Mailing Address - Phone:407-649-6884
Mailing Address - Fax:407-245-7059
Practice Address - Street 1:77 W UNDERWOOD ST FL 3
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1122
Practice Address - Country:US
Practice Address - Phone:407-649-6884
Practice Address - Fax:407-245-7059
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program