Provider Demographics
NPI:1659978161
Name:EVANS, VALERIE KATHRYN
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:KATHRYN
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:863 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-1839
Mailing Address - Country:US
Mailing Address - Phone:937-684-2455
Mailing Address - Fax:
Practice Address - Street 1:767 RICHARD DR.
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-4538
Practice Address - Country:US
Practice Address - Phone:937-372-4485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No376J00000XNursing Service Related ProvidersHomemaker