Healthcare Provider Details

I. General information

NPI: 1558080689
Provider Name (Legal Business Name): KELLY SILVERS EVANS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 MALL BLVD
SAVANNAH GA
31406-4888
US

IV. Provider business mailing address

420 MALL BLVD
SAVANNAH GA
31406-4888
US

V. Phone/Fax

Practice location:
  • Phone: 912-644-5809
  • Fax:
Mailing address:
  • Phone: 912-644-5809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN196730
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: