Provider Demographics
NPI:1245966712
Name:EVANS, KIMBERLY SUSAN (DH)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:SUSAN
Last Name:EVANS
Suffix:
Gender:F
Credentials:DH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 W HAYWARD DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-6329
Mailing Address - Country:US
Mailing Address - Phone:417-466-7196
Mailing Address - Fax:417-466-4081
Practice Address - Street 1:1050 W HAYWARD DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-6329
Practice Address - Country:US
Practice Address - Phone:417-466-7196
Practice Address - Fax:417-466-4081
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist