Healthcare Provider Details

I. General information

NPI: 1285387555
Provider Name (Legal Business Name): KENDRA NICHOLE EVANS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S JACKSON HWY STE 100
SHEFFIELD AL
35660-5769
US

IV. Provider business mailing address

215 JORDAN LN
FLORENCE AL
35630-8913
US

V. Phone/Fax

Practice location:
  • Phone: 256-314-2550
  • Fax:
Mailing address:
  • Phone: 256-627-1460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number1-162244
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08211085
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: