Healthcare Provider Details

I. General information

NPI: 1497305171
Provider Name (Legal Business Name): KENITHIA EVANS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 06/18/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6966 CHESSGATE FALLS LN
RICHMOND TX
77469-1818
US

IV. Provider business mailing address

6966 CHESSGATE FALLS LN
RICHMOND TX
77469-1818
US

V. Phone/Fax

Practice location:
  • Phone: 832-484-2066
  • Fax:
Mailing address:
  • Phone: 832-484-2066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number811000
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number811000
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number811000
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number811000
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number811000
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: