Healthcare Provider Details

I. General information

NPI: 1477583326
Provider Name (Legal Business Name): EVANS TOTAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 11/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 LAKE ST
FULTON KY
42041-1544
US

IV. Provider business mailing address

208 LAKE ST
FULTON KY
42041-1544
US

V. Phone/Fax

Practice location:
  • Phone: 270-472-2984
  • Fax: 270-472-9377
Mailing address:
  • Phone: 270-472-2984
  • Fax: 270-472-9377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberMG0530
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMG0530
License Number StateKY

VIII. Authorized Official

Name: DR. DAVID STEWART PRATER JR.
Title or Position: OWNER
Credential: PHARM D.
Phone: 270-472-2984