Provider Demographics
NPI:1427801034
Name:MCGEVNA, KIM EVELYN (EDS)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:EVELYN
Last Name:MCGEVNA
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1884 VALLEY FORGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-1835
Mailing Address - Country:US
Mailing Address - Phone:727-512-0981
Mailing Address - Fax:
Practice Address - Street 1:1884 VALLEY FORGE DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-1835
Practice Address - Country:US
Practice Address - Phone:727-512-0981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare