Healthcare Provider Details

I. General information

NPI: 1821096124
Provider Name (Legal Business Name): KIMBERLEY ANN EVANS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 TOWNEPARK CIR STE 100
LOUISVILLE KY
40243-2318
US

IV. Provider business mailing address

205 TOWNEPARK CIR STE 100
LOUISVILLE KY
40243-2318
US

V. Phone/Fax

Practice location:
  • Phone: 502-253-4554
  • Fax:
Mailing address:
  • Phone: 502-253-4554
  • Fax: 877-273-4414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number3002534
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number1037185
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: