MEDICARE: DR. KADESHA CLARK EVANS PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	G182509	IA

General Provider Information

NPI Number	:	1770303547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KADESHA CLARK EVANS PMHNP-BC

Provider Business Mailing Address
First Line	:	1566 S GILBERT ST UNIT 1023
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4304
Country	:	US
Telephone Number	:	319-853-8378
Fax Number	:	319-253-3915

Provider Business Practice Location Address
First Line	:	1566 S GILBERT ST UNIT 1023
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4304
Country	:	US
Telephone Number	:	319-853-8378
Fax Number	:

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

Provider Enumeration Date	:	10/15/2024
Last Update Date	:	05/06/2025

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