Evelyn Ebarle Ebalo, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD00028453 Issued in WA

Practice address

1920 Black Lake Blvd SW
Olympia, WA 98512-5651

Phone

(360) 534-9222

Fax

(360) 534-9223

NPI assigned

Dec 22, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1881671618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 BLACK LAKE BLVD SW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985125651",
            "telephone_number": "360-534-9222",
            "fax_number": "360-534-9223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 BLACK LAKE BLVD SW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985125651",
            "telephone_number": "360-534-9222",
            "fax_number": "360-534-9223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBALO",
        "first_name": "EVELYN",
        "middle_name": "EBARLE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-22",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00028453",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "EB5698",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8128340",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Olympia, WA
• Providers in Olympia, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.