1487635827 NPI number — JENNIFER L EVANS PHARMD

Table of content: JENNIFER L EVANS PHARMD (NPI 1487635827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487635827 NPI number — JENNIFER L EVANS PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANS
Provider First Name:
JENNIFER
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487635827
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2016 CARTER MILL WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKEVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20833-2243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-498-3971
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2480 LLEWELLYN AVE
Provider Second Line Business Practice Location Address:
KIMBROUGH AMBULATORY CARE CENTER
Provider Business Practice Location Address City Name:
FORT MEADE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20755-5800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-677-8395
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P0018X , with the licence number:  15642 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: 15642 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)