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NPI Code Detail

MEDICARE: MS. DEIDRA KYIESHA EVANS LPC

MEDICARE: MS. DEIDRA KYIESHA EVANS LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor2026017115MO

General Provider Information

NPI Number : 1386418572
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DEIDRA KYIESHA EVANS LPC
Provider Business Mailing Address
First Line : PO BOX 844715
Second Line :
City : KANSAS CITY
State : MO
Zip : 64184-4715
Country : US
Telephone Number : 417-761-5214
Fax Number : 417-761-5065
Provider Business Practice Location Address
First Line : 1001 LYNCH ST
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63118-1818
Country : US
Telephone Number : 314-535-5600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2023
Last Update Date : 06/15/2026

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