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General NPI Number Information
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NPI Number | 1114542883
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Entity Type | Individual
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Provider Name | KIM EVANS CMT, LE, MA
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Gender | Female
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Dates
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Enumeration Date | 06/09/2020
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Last Update Date | 06/09/2020
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Provider Practice Location Address
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Address Line | 101 GREGORY LN STE 25
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City | PLEASANT HILL
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State | CA
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Zip | 94523-4915
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Country | US
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Telephone | 925-639-1629
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4403
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City | WALNUT CREEK
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State | CA
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Zip | 94596-0403
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Country | US
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Telephone | 925-639-1629
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 43135
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License Number State | CA
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