Provider Demographics
NPI:1588697890
Name:KINSEL-EVANS, HEATHER N (MD)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:N
Last Name:KINSEL-EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:NIZHONII
Other - Last Name:KINSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1725 WESTERN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1390
Mailing Address - Country:US
Mailing Address - Phone:419-423-4994
Mailing Address - Fax:360-428-6485
Practice Address - Street 1:1725 WESTERN AVE STE A
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1390
Practice Address - Country:US
Practice Address - Phone:419-423-4994
Practice Address - Fax:360-428-2596
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60270481207Q00000X
NMMD2009-0495207Q00000X
IDMR-0873207Q00000X
TXR1064207Q00000X
OH35.143743207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMTIN & NPIOtherBCBS OF NM
OH0474209Medicaid
NM55279589Medicaid
ID807491200Medicaid
NMTIN & NPIOtherBCBS OF NM