Healthcare Provider Details

I. General information

NPI: 1164387452
Provider Name (Legal Business Name): VICTORIA-KATE EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 BAYWOOD LN
VILLA RICA GA
30180-3854
US

IV. Provider business mailing address

6974 SPRINGWOOD DR
DOUGLASVILLE GA
30135-1543
US

V. Phone/Fax

Practice location:
  • Phone: 943-231-8136
  • Fax:
Mailing address:
  • Phone: 943-231-8136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN306660
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: