Individual
KELLEY EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6634 HIGHWAY 35 N, FOREST, MS 39074-9674
(601) 813-3638
Mailing address
6634 HIGHWAY 35 N, FOREST, MS 39074-9674
(601) 813-3638
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
801255243
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141930996
—
MS
Enumeration date
02/04/2013
Last updated
02/04/2013
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