Provider Demographics
NPI:1750350344
Name:EVANS, MICHAEL KENT (CRNA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KENT
Last Name:EVANS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 N RUTLAND ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3837
Mailing Address - Country:US
Mailing Address - Phone:316-636-2519
Mailing Address - Fax:316-636-1014
Practice Address - Street 1:1215 N RUTLAND ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3837
Practice Address - Country:US
Practice Address - Phone:316-636-2519
Practice Address - Fax:316-636-1014
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-35996-122367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS144571OtherBLUE SHIELD