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: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 GOLDEN EAGLE DR
MONETA VA
24121-5964
US

IV. Provider business mailing address

1095 GOLDEN EAGLE DR
MONETA VA
24121-5964
US

V. Phone/Fax

Practice location:
  • Phone: 540-297-7151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126004344
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: