Healthcare Provider Details

I. General information

NPI: 1811746803
Provider Name (Legal Business Name): KATHRYN EVANS M.S., LAT, ATC, CES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAXON DR
ALFRED NY
14802-1232
US

IV. Provider business mailing address

1 SAXON DR
ALFRED NY
14802-1232
US

V. Phone/Fax

Practice location:
  • Phone: 607-871-2193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number005165
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: