Provider Demographics
NPI:1649807470
Name:EVANS, KYMBYATTA G (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:KYMBYATTA
Middle Name:G
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:KYMBYATTA
Other - Middle Name:
Other - Last Name:GASTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:6496 BELLEVUE DR SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-4779
Mailing Address - Country:US
Mailing Address - Phone:770-873-6769
Mailing Address - Fax:
Practice Address - Street 1:6496 BELLEVUE DR SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-4779
Practice Address - Country:US
Practice Address - Phone:770-873-6769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN140835163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Single Specialty