Healthcare Provider Details

I. General information

NPI: 1063161495
Provider Name (Legal Business Name): EVAN PHILLIP SINGLETON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 PROGRESS DR
MOUNT VERNON KY
40456-8590
US

IV. Provider business mailing address

116 PROGRESS DR
MOUNT VERNON KY
40456-8590
US

V. Phone/Fax

Practice location:
  • Phone: 606-256-2143
  • Fax:
Mailing address:
  • Phone: 606-256-2143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number01096118A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number62252
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: