Healthcare Provider Details

I. General information

NPI: 1518144583
Provider Name (Legal Business Name): SHELBY EVANS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 E 22ND ST N STE 1600-B
WICHITA KS
67226-2388
US

IV. Provider business mailing address

8100 E 22ND ST N STE 1600-B
WICHITA KS
67226-2388
US

V. Phone/Fax

Practice location:
  • Phone: 316-201-6462
  • Fax: 316-201-6428
Mailing address:
  • Phone: 316-201-6462
  • Fax: 316-201-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1921
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1073513
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: