Provider Demographics
NPI:1720454309
Name:EVANS, KIRYN (FNP-C, FPA)
Entity Type:Individual
Prefix:
First Name:KIRYN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:FNP-C, FPA
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1051 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:KEWANEE
Mailing Address - State:IL
Mailing Address - Zip Code:61443-8354
Mailing Address - Country:US
Mailing Address - Phone:309-852-7700
Mailing Address - Fax:
Practice Address - Street 1:5016 N UNIVERSITY ST STE 104
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4763
Practice Address - Country:US
Practice Address - Phone:217-491-0355
Practice Address - Fax:309-226-6057
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.000347363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily