Provider Demographics
NPI:1891580676
Name:EVANS, KALEY NICOLE
Entity type:Individual
Prefix:
First Name:KALEY
Middle Name:NICOLE
Last Name:EVANS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74018-0446
Mailing Address - Country:US
Mailing Address - Phone:918-341-1424
Mailing Address - Fax:
Practice Address - Street 1:1219 W DUPONT ST
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-5318
Practice Address - Country:US
Practice Address - Phone:918-341-1424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator