Individual
SHANNON KELLY EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4123 DUTCHMANS LN STE 301, LOUISVILLE, KY 40207-4721
(802) 847-2700
Mailing address
111 COLCHESTER AVE, BURLINGTON, VT 05401-1473
(802) 847-2700
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
042.0012902
VT
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
50218
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2011
Last updated
11/11/2024
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