Healthcare Provider Details

I. General information

NPI: 1417182734
Provider Name (Legal Business Name): JAMIE KARYL EVANS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2009
Last Update Date: 05/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N HERRING RD
OPELIKA AL
36804-1861
US

IV. Provider business mailing address

100 N HERRING RD
OPELIKA AL
36804-1861
US

V. Phone/Fax

Practice location:
  • Phone: 706-573-4461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License NumberRN200910
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: