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General NPI Number Information
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NPI Number | 1740595073
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Entity Type | Individual
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Provider Name | CAREY RENEA EVANS CST, KCSA
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Gender | Female
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Dates
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Enumeration Date | 08/11/2010
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 1102 TRIPLETT ST STE 2100
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City | OWENSBORO
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State | KY
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Zip | 42303-3156
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Country | US
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Telephone | 270-685-8235
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Fax | 270-685-8238
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Provider Business Mailing Address
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Address Line | 1921 VILLAGE RUN
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City | OWENSBORO
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State | KY
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Zip | 42303-4020
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Country | US
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Telephone | 270-314-1035
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | SA213
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License Number State | KY
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