Provider Demographics
NPI:1447975032
Name:EVANS-KEGLEY, AMY L (APRN-CNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:EVANS-KEGLEY
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 WAR ADMIRAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-4780
Mailing Address - Country:US
Mailing Address - Phone:301-992-1242
Mailing Address - Fax:
Practice Address - Street 1:1050 KEY PKWY STE 102
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4496
Practice Address - Country:US
Practice Address - Phone:240-215-1138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV114528363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily