Active NPI
Keith Evashevski, PSY.D.
- Clinical Psychologist
- Laramie, WY
National Provider Identifier
1346418753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 382
- Practice address
- 1050 N 3Rd St
Suite B1
Laramie, WY 82072-2544 - Phone
- (307) 742-9766
- NPI assigned
- Feb 19, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 382 | WY | Primary |
Addresses
Primary practice location
1050 N 3Rd St
Suite B1
Laramie, WY 82072-2544
Mailing address
1214 Shield St
Laramie, WY 82072-2244
Phone (307) 761-0615
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 382 | WY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203379200000",
"number": "1346418753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1214 SHIELD ST",
"city": "LARAMIE",
"state": "WY",
"postal_code": "820722244",
"telephone_number": "307-761-0615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1050 N 3RD ST",
"address_2": "SUITE B1",
"city": "LARAMIE",
"state": "WY",
"postal_code": "820722544",
"telephone_number": "307-742-9766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVASHEVSKI",
"first_name": "KEITH",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-19",
"last_updated": "2008-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WY",
"license": "382",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Laramie, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.