Provider Demographics
NPI:1740595073
Name:EVANS, CAREY RENEA (CST, KCSA)
Entity Type:Individual
Prefix:MS
First Name:CAREY
Middle Name:RENEA
Last Name:EVANS
Suffix:
Gender:F
Credentials:CST, KCSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 VILLAGE RUN
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-4020
Mailing Address - Country:US
Mailing Address - Phone:270-314-1035
Mailing Address - Fax:
Practice Address - Street 1:1102 TRIPLETT ST STE 2100
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3156
Practice Address - Country:US
Practice Address - Phone:270-685-8235
Practice Address - Fax:270-685-8238
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA213246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant