Healthcare Provider Details

I. General information

NPI: 1780137364
Provider Name (Legal Business Name): KRISTIN EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 HAWKINS DR
SEARCY AR
72143-4801
US

IV. Provider business mailing address

2921 HAWKINS DR
SEARCY AR
72143-4801
US

V. Phone/Fax

Practice location:
  • Phone: 501-268-2513
  • Fax: 501-279-1328
Mailing address:
  • Phone: 501-268-2513
  • Fax: 501-279-1328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4161
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: