Provider Demographics
NPI:1447338777
Name:EVETTS, KEVIN JEFFREY
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JEFFREY
Last Name:EVETTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 ESTATE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0601
Mailing Address - Country:US
Mailing Address - Phone:901-683-3511
Mailing Address - Fax:
Practice Address - Street 1:920 ESTATE DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0601
Practice Address - Country:US
Practice Address - Phone:901-683-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist