Provider Demographics
NPI:1952819740
Name:EVANS, IYANNA KREE
Entity Type:Individual
Prefix:
First Name:IYANNA
Middle Name:KREE
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5275 VISTA BLVD STE A1
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-0840
Mailing Address - Country:US
Mailing Address - Phone:775-870-5257
Mailing Address - Fax:
Practice Address - Street 1:5275 VISTA BLVD STE A1
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-0840
Practice Address - Country:US
Practice Address - Phone:775-870-5257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health