Provider Demographics
NPI:1356521330
Name:EVANS, TRACI L
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:L
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:VANCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41179-7924
Mailing Address - Country:US
Mailing Address - Phone:606-796-2228
Mailing Address - Fax:
Practice Address - Street 1:349 ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:VANCEBURG
Practice Address - State:KY
Practice Address - Zip Code:41179-7924
Practice Address - Country:US
Practice Address - Phone:606-796-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist