Provider Demographics
NPI:1770799124
Name:EVANS-RANKIN, KELLY LEE (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LEE
Last Name:EVANS-RANKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:LEE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7500 STATE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-2439
Mailing Address - Country:US
Mailing Address - Phone:513-624-4500
Mailing Address - Fax:
Practice Address - Street 1:8000 5 MILE RD STE 105
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2187
Practice Address - Country:US
Practice Address - Phone:513-233-6980
Practice Address - Fax:513-233-6983
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44125207Q00000X, 207QS0010X
OH35.138436207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100191900Medicaid
KY7100191900Medicaid