Provider Demographics
NPI:1669123238
Name:EVANS, KALEISHA
Entity type:Individual
Prefix:MRS
First Name:KALEISHA
Middle Name:
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 1:3700 HUECO VALLEY DR APT 3103
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-5439
Mailing Address - Country:US
Mailing Address - Phone:915-412-5803
Mailing Address - Fax:
Practice Address - Street 1:3700 HUECO VALLEY DR APT 3103
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-5439
Practice Address - Country:US
Practice Address - Phone:915-412-5803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator
No251B00000XAgenciesCase Management
No305S00000XManaged Care OrganizationsPoint of Service
No372600000XNursing Service Related ProvidersAdult Companion