Healthcare Provider Details

I. General information

NPI: 1194168013
Provider Name (Legal Business Name): KENNETH D EVANS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 S ORANGE ST
MISSOULA MT
59801-1810
US

IV. Provider business mailing address

317 S ORANGE ST
MISSOULA MT
59801-1810
US

V. Phone/Fax

Practice location:
  • Phone: 406-549-1951
  • Fax: 406-542-5682
Mailing address:
  • Phone: 406-549-1951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3295
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3095
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number3095
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: