Provider Demographics
NPI:1942581368
Name:EVANS, MARCY L (PA)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:L
Last Name:EVANS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARCY
Other - Middle Name:L
Other - Last Name:SUDBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1005 N B ST
Mailing Address - Street 2:
Mailing Address - City:HERINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67449-1600
Mailing Address - Country:US
Mailing Address - Phone:785-258-5130
Mailing Address - Fax:
Practice Address - Street 1:711 GENN DR
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-1179
Practice Address - Country:US
Practice Address - Phone:785-456-6288
Practice Address - Fax:785-456-8139
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01513363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant