Provider Demographics
NPI:1649227448
Name:EVANS, ANDREA DAWN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:DAWN
Last Name:EVANS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 MCCULLOUGH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-4450
Mailing Address - Country:US
Mailing Address - Phone:606-585-7897
Mailing Address - Fax:833-922-1959
Practice Address - Street 1:1740 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7653
Practice Address - Country:US
Practice Address - Phone:606-585-7897
Practice Address - Fax:833-922-1959
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY128894103TC0700X, 103T00000X
OH6090103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0920801OtherPTAN
KY2527555Medicaid
KY128894OtherKENTUCKY BOARD OF EXAMINERS OF PSYCHOLOGY
KY588202Medicare UPIN