Healthcare Provider Details

I. General information

NPI: 1003498973
Provider Name (Legal Business Name): EVOLVE PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 US 41 N STE B
HENDERSON KY
42420-2376
US

IV. Provider business mailing address

2480H US 41 N STE 80
HENDERSON KY
42420-2359
US

V. Phone/Fax

Practice location:
  • Phone: 812-228-6896
  • Fax:
Mailing address:
  • Phone: 270-823-3875
  • Fax: 270-212-0271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KASIE A BALLARD
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: MS, OTR/L
Phone: 812-228-6896