MEDICARE: MRS. TERRI JEAN EVANS REGISTERED NURSE

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	163WC1500X	Community Health Registered Nurse	R076851	AR
2	163WH0200X	Home Health Registered Nurse	R076851	AR

General Provider Information

NPI Number	:	1952818353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERRI JEAN EVANS REGISTERED NURSE

Provider Business Mailing Address
First Line	:	PO BOX 94545
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72190-4545
Country	:	US
Telephone Number	:	501-420-3703
Fax Number	:

Provider Business Practice Location Address
First Line	:	4601 JFK BLVD STE 94025
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7310
Country	:	US
Telephone Number	:	501-420-3703
Fax Number	:

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

Provider Enumeration Date	:	01/07/2018
Last Update Date	:	04/21/2020

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