Healthcare Provider Details

I. General information

NPI: 1659978161
Provider Name (Legal Business Name): VALERIE KATHRYN EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 RICHARD DR.
XENIA OH
45385-4538
US

IV. Provider business mailing address

863 MORNINGSIDE DR
XENIA OH
45385-1839
US

V. Phone/Fax

Practice location:
  • Phone: 937-372-4485
  • Fax:
Mailing address:
  • Phone: 937-684-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: