Healthcare Provider Details

I. General information

NPI: 1720454309
Provider Name (Legal Business Name): KIRYN EVANS FNP-C, FPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN SIMMONS

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5016 N UNIVERSITY ST STE 104
PEORIA IL
61614-4763
US

IV. Provider business mailing address

1051 W SOUTH ST
KEWANEE IL
61443-8354
US

V. Phone/Fax

Practice location:
  • Phone: 217-491-0355
  • Fax: 309-226-6057
Mailing address:
  • Phone: 309-852-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277.000347
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: