Healthcare Provider Details

I. General information

NPI: 1215841192
Provider Name (Legal Business Name): EASTON EVANS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CARTER RD
LEIGHTON AL
35646-3151
US

IV. Provider business mailing address

18 CARTER RD
LEIGHTON AL
35646-3151
US

V. Phone/Fax

Practice location:
  • Phone: 256-740-1498
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number2100339
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: