Individual
KENNETH LEE EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
711 S MUSKOGEE AVE, TAHLEQUAH, OK 74464-4717
(918) 207-0078
Mailing address
1304 S WILLEY ST, FORT GIBSON, OK 74434-7813
(405) 445-2009
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/14/2014
Last updated
08/14/2014
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