Individual
MR. DANIEL KYLE EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
EFFINGHAM ST BLDG 36, PORTSMOUTH, VA 23708-7000
(757) 953-4688
Mailing address
10168 KEPPLER DR, SAN DIEGO, CA 92124-2504
(252) 503-3821
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568180438
DOD
—
Enumeration date
08/17/2022
Last updated
01/11/2023
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