Individual
AMBER EVENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
410 W 16TH AVE, TYNDALL, SD 57066-2318
(605) 589-2190
(605) 589-4603
Mailing address
BON HOMME FAMILY PRACTICE, 410 W 16TH AVE, TYNDALL, SD 57066-5209
(605) 589-2190
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1011
SD
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2010785
—
SD
Enumeration date
09/15/2015
Last updated
05/21/2019
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