Healthcare Provider Details

I. General information

NPI: 1396840500
Provider Name (Legal Business Name): KIMBERLEY DORENE EVANS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 06/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 S MYRTLE AVE
CLEARWATER FL
33756-3469
US

IV. Provider business mailing address

1227 S MYRTLE AVE
CLEARWATER FL
33756-3469
US

V. Phone/Fax

Practice location:
  • Phone: 727-939-6196
  • Fax: 727-350-9396
Mailing address:
  • Phone: 727-939-6196
  • Fax: 727-350-9396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME0085477
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: