MEDICARE: JARA FREEMAN EVANS CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	1-139285	AL
2	363L00000X	Nurse Practitioner	RN299167	GA

General Provider Information

NPI Number	:	1326591033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARA FREEMAN EVANS CRNP

Provider Business Mailing Address
First Line	:	44 KROG ST NE UNIT 701
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-2658
Country	:	US
Telephone Number	:	205-441-0176
Fax Number	:

Provider Business Practice Location Address
First Line	:	531 BROADWAY E # 10
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-5023
Country	:	US
Telephone Number	:	503-684-8252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2016
Last Update Date	:	02/03/2021

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