Provider Demographics
NPI:1790923563
Name:EVANS, KATHLEEN ERIN (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ERIN
Last Name:EVANS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4312
Mailing Address - Country:US
Mailing Address - Phone:256-519-8104
Mailing Address - Fax:256-519-8327
Practice Address - Street 1:2525 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-5934
Practice Address - Country:US
Practice Address - Phone:256-840-4580
Practice Address - Fax:256-840-4585
Is Sole Proprietor?:No
Enumeration Date:2009-02-01
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1207R00000X
AL1516207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine