Healthcare Provider Details

I. General information

NPI: 1740255199
Provider Name (Legal Business Name): JAMES EVENSON AUDIOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N WALDRON ST
HUTCHINSON KS
67502-1131
US

IV. Provider business mailing address

2101 N WALDRON ST
HUTCHINSON KS
67502-1131
US

V. Phone/Fax

Practice location:
  • Phone: 620-669-2500
  • Fax: 620-694-2170
Mailing address:
  • Phone: 620-669-2500
  • Fax: 620-694-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1174
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: