Provider Demographics
NPI:1972332732
Name:EVANS, KATHY ANN I (SERVICE COORDINATOR)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ANN
Last Name:EVANS
Suffix:I
Gender:F
Credentials:SERVICE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 TREASURE LN
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:WV
Mailing Address - Zip Code:24946-8753
Mailing Address - Country:US
Mailing Address - Phone:304-646-7117
Mailing Address - Fax:
Practice Address - Street 1:128 TREASURE LN
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:WV
Practice Address - Zip Code:24946-8753
Practice Address - Country:US
Practice Address - Phone:304-646-7117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency