Provider Demographics
NPI:1457966277
Name:EVANS, DEMONTE JEROD
Entity type:Individual
Prefix:
First Name:DEMONTE
Middle Name:JEROD
Last Name:EVANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 25TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-1103
Mailing Address - Country:US
Mailing Address - Phone:304-544-2385
Mailing Address - Fax:
Practice Address - Street 1:1231 25TH ST APT 2
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-1103
Practice Address - Country:US
Practice Address - Phone:304-544-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant