Provider Demographics
NPI:1821096124
Name:EVANS, KIMBERLEY ANN (ARNP)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:ANN
Last Name:EVANS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 TOWNEPARK CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2318
Mailing Address - Country:US
Mailing Address - Phone:502-253-4554
Mailing Address - Fax:877-273-4414
Practice Address - Street 1:205 TOWNEPARK CIR STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2318
Practice Address - Country:US
Practice Address - Phone:502-253-4554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002534364SA2200X
KY1037185163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000272732OtherANTHEM PIN
KY300136183OtherTAX ID USED FOR OTHER INS
KYP00125503Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER
KY7753Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
KY0775301Medicare PIN
KYS56808Medicare UPIN