MEDICARE: BETH EVANS

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	363LG0600X	Gerontology Nurse Practitioner	A03396 ANP	AR

General Provider Information

NPI Number	:	1871890046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH EVANS

Provider Business Mailing Address
First Line	:	114 JAMIE LN
Second Line	:
City	:	BEEBE
State	:	AR
Zip	:	72012-9606
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 S BOWMAN RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-4136
Country	:	US
Telephone Number	:	501-288-2136
Fax Number	:

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

Provider Enumeration Date	:	02/23/2011
Last Update Date	:	02/23/2011

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Directions to “ BETH EVANS ” Practice Location

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