Individual
JESSICA MARIE EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3535 SOUTHERN BLVD., KETTERING, OH 45429-1221
(937) 395-8166
Mailing address
3131 NEWMARK DR STE 220, MIAMISBURG, OH 45342-5400
(937) 438-8910
(937) 436-4984
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35.122407
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0096394
—
OH
Enumeration date
04/06/2012
Last updated
07/17/2019
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