Healthcare Provider Details

I. General information

NPI: 1548362957
Provider Name (Legal Business Name): KIRSTEN E EVANS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 TOWN CENTER DR STE 413
RESTON VA
20190-3240
US

IV. Provider business mailing address

1800 TOWN CENTER DR STE 413
RESTON VA
20190-3240
US

V. Phone/Fax

Practice location:
  • Phone: 703-435-0808
  • Fax:
Mailing address:
  • Phone: 703-435-0808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101235296
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: