MEDICARE: DR. HENRIETTA VALAIR EVANS DNP APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP118936	TX
2	163WW0000X	Wound Care Registered Nurse	AP118936	TX
3	363LG0600X	Gerontology Nurse Practitioner	AP118936	TX
4	163W00000X	Registered Nurse	711274	TX

General Provider Information

NPI Number	:	1366768277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRIETTA VALAIR EVANS DNP APRN

Provider Business Mailing Address
First Line	:	855 ROCKMEAD DR STE 604
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2102
Country	:	US
Telephone Number	:	832-879-2107
Fax Number	:	832-442-5044

Provider Business Practice Location Address
First Line	:	855 ROCKMEAD DR STE 604
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2102
Country	:	US
Telephone Number	:	832-879-2107
Fax Number	:	832-442-5044

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

Provider Enumeration Date	:	04/16/2010
Last Update Date	:	03/08/2025

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