MEDICARE: BEVERLY KAYE EVANS L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	29	OK

General Provider Information

NPI Number	:	1326199548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY KAYE EVANS L.C.S.W.

Provider Business Mailing Address
First Line	:	PO BOX 60383
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73146-0383
Country	:	US
Telephone Number	:	405-848-4459
Fax Number	:	405-848-4459

Provider Business Practice Location Address
First Line	:	1029 NW 46TH ST
Second Line	:	#5
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-6447
Country	:	US
Telephone Number	:	405-848-4459
Fax Number	:	405-848-4459

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	05/26/2009

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