Kathy Jean Evans, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R543446 Issued in MS

Practice address

210 E Main St
Tupelo, MS 38804-4017

Phone

(662) 255-0467

Fax

(662) 620-7106

NPI assigned

Jun 2, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Heale Counseling, LLC

  • Mental Health Counselor
  • Tupelo, MS
  • NPI 1093410243

  Psychiatric/Mental Health

  NPD
• Pax House Counseling and Play Therapy LLC

  • Professional Counselor
  • Tupelo, MS
  • NPI 1356175426
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433289600000",
    "number": "1629016795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 E MAIN ST",
            "address_2": "STE B",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388044017",
            "telephone_number": "662-255-0467",
            "fax_number": "662-620-7106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 E MAIN ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388044017",
            "telephone_number": "662-255-0467",
            "fax_number": "662-620-7106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "KATHY",
        "middle_name": "JEAN",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-02",
        "last_updated": "2015-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "R543446",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00124239",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eterna Primary Care of Mississippi LLC
• Audrey Dale Ethridge, PMHNP-BC, MSN
• Travis A Eubanks, DO
• Breanna Evans, PMHNP-BC
• Cynthia Evans
• Kristy Evans, LSW
• Lisa M Evans, BA
• Virginia Evans
• Angelia Futato Everett, LCSW
• John Everett, PT

• Psychiatric/Mental Health Nurse Practitioner in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Psychiatric/Mental Health Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.