Provider Demographics
NPI:1710266630
Name:EVANS, KRISTEN N (APRN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:N
Last Name:EVANS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:NICHOLE
Other - Last Name:KIRCHBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, RN
Mailing Address - Street 1:171 N EAGLE CREEK DR STE 106
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1801
Mailing Address - Country:US
Mailing Address - Phone:859-277-9112
Mailing Address - Fax:859-277-7105
Practice Address - Street 1:171 N EAGLE CREEK DR STE 106
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1801
Practice Address - Country:US
Practice Address - Phone:859-277-9112
Practice Address - Fax:859-277-7105
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100249550Medicaid