Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4313 | OK |
NPI | 1003402280 |
---|---|
Provider Name | Kathryn Nicole Evans |
First Address | Edmond, OK 73013-4775 |
Second Address | Edmond, OK 73013-4129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2020 |
Last Update Date | 12/12/2020 |