Healthcare Provider Details

I. General information

NPI: 1336805779
Provider Name (Legal Business Name): VIRGINIA CATHERINE EVANS APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 FRANKFORT RD STE 103
SHELBYVILLE KY
40065-7401
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-844-2888
  • Fax: 502-394-3650
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3017178
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: