Provider Demographics
NPI:1801776943
Name:EVANS, KATRICE TRENAY
Entity type:Individual
Prefix:
First Name:KATRICE
Middle Name:TRENAY
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3293 BRATER AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-2101
Mailing Address - Country:US
Mailing Address - Phone:513-975-7464
Mailing Address - Fax:
Practice Address - Street 1:3293 BRATER AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-2101
Practice Address - Country:US
Practice Address - Phone:513-975-7564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSM149570172A00000X
OH188492164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No172A00000XOther Service ProvidersDriver