Provider Demographics
NPI:1134938079
Name:EVANS, KELSEY JEAN (LVN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:JEAN
Last Name:EVANS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1848 BEMBOW DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-3350
Mailing Address - Country:US
Mailing Address - Phone:530-356-9629
Mailing Address - Fax:
Practice Address - Street 1:1147 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2113
Practice Address - Country:US
Practice Address - Phone:530-222-7213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA718696101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)