Provider Demographics
NPI:1689015588
Name:EVANS, KATHRYN MCINVALE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MCINVALE
Last Name:EVANS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:LYNN
Other - Last Name:MCINVALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:655 SOUTH 7TH STREET BLDG 700/700A
Mailing Address - Street 2:78 MDG OMRS/SGXO
Mailing Address - City:ROBINS AFB
Mailing Address - State:GA
Mailing Address - Zip Code:31098
Mailing Address - Country:US
Mailing Address - Phone:478-222-7911
Mailing Address - Fax:
Practice Address - Street 1:655 SOUTH 7TH STREET BLDG 700/700A
Practice Address - Street 2:78 MDG OMRS/SGXO
Practice Address - City:ROBINS AFB
Practice Address - State:GA
Practice Address - Zip Code:31098-3109
Practice Address - Country:US
Practice Address - Phone:478-222-7911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6875363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6875OtherPHYSICIAN ASSISTANT
GAME5288368OtherDEA