Individual
MICKI JADE EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1501 LAKESIDE DR, LYNCHBURG, VA 24501-3113
(434) 544-8100
Mailing address
601 TRENTS FERRY RD, LYNCHBURG, VA 24503-1117
(434) 544-1500
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
A60432457
VA
Other
Enumeration date
08/16/2014
Last updated
08/16/2014
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