Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 201208 | NC |
NPI | 1073596466 |
---|---|
Provider Name | Mrs. Kim Houser Evans |
First Address | Hickory, NC 28601-5212 |
Second Address | Hickory, NC 28601-5212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2005 |
Last Update Date | 17/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q26251 | (02) | NC |