# MS. KATHLEEN KAY EVANS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1063594893
- **Gender:** F
- **Credential:** NP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 4704149925 | MI | Yes |

## Other

- **Enumeration date:** 10/20/2006
- **Last updated:** 09/18/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 200000002317 | PHP PIN \# | MI |
| 01 | — | 5008763770 | BCBS INDIVIDUAL PIN | MI |