Healthcare Provider Details

I. General information

NPI: 1992131445
Provider Name (Legal Business Name): CALVIN CALEB EVANS FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S BROADWAY AVE
SALEM OH
44460-3002
US

IV. Provider business mailing address

PO BOX 3095
DUBLIN OH
43016-0046
US

V. Phone/Fax

Practice location:
  • Phone: 220-270-6900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.15131-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.327283
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: