Provider Demographics
NPI:1437272598
Name:EVANS, CORTNEY FAITH (DO)
Entity type:Individual
Prefix:DR
First Name:CORTNEY
Middle Name:FAITH
Last Name:EVANS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 CHAPPELL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2707
Mailing Address - Country:US
Mailing Address - Phone:304-687-2189
Mailing Address - Fax:
Practice Address - Street 1:830 PENNSYLVANIA AVE
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS SUITE 104
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3302
Practice Address - Country:US
Practice Address - Phone:304-388-1552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2151208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810009326Medicaid
WVEV6036021Medicare PIN