Healthcare Provider Details

I. General information

NPI: 1316825094
Provider Name (Legal Business Name): KAYLEEN EVANGELISTA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 W LANCASTER BLVD
LANCASTER CA
93534-2131
US

IV. Provider business mailing address

1630 W LANCASTER BLVD
LANCASTER CA
93534-2131
US

V. Phone/Fax

Practice location:
  • Phone: 661-466-9886
  • Fax:
Mailing address:
  • Phone: 661-466-9886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP95036412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: