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NPI Code Detail

MEDICARE: KIRYN EVANS FNP-C, FPA

MEDICARE:   KIRYN  EVANS  FNP-C, FPA
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
1363LF0000XFamily Nurse Practitioner277.000347IL

General Provider Information

NPI Number : 1720454309
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIRYN EVANS FNP-C, FPA
Provider Business Mailing Address
First Line : 1051 W SOUTH ST
Second Line :
City : KEWANEE
State : IL
Zip : 61443-8354
Country : US
Telephone Number : 309-852-7700
Fax Number :
Provider Business Practice Location Address
First Line : 5016 N UNIVERSITY ST STE 104
Second Line :
City : PEORIA
State : IL
Zip : 61614-4763
Country : US
Telephone Number : 217-491-0355
Fax Number : 309-226-6057
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2015
Last Update Date : 11/25/2019

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Directions to “ KIRYN EVANS FNP-C, FPA” Practice Location

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