Individual
KENNETH EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
637 ROYAL AVE, MIDWEST CITY, OK 73130-2710
(405) 733-5396
Mailing address
637 ROYAL AVE, MIDWEST CITY, OK 73130-2710
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
P080455262
—
OK
Enumeration date
10/28/2009
Last updated
10/28/2009
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