Healthcare Provider Details

I. General information

NPI: 1578583209
Provider Name (Legal Business Name): ROY LEE EVANS JR. NNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7545 W REDBIRD RD
PEORIA AZ
85383-6253
US

IV. Provider business mailing address

7545 W REDBIRD RD
PEORIA AZ
85383-6253
US

V. Phone/Fax

Practice location:
  • Phone: 480-510-1599
  • Fax: 623-258-4136
Mailing address:
  • Phone: 480-510-1599
  • Fax: 623-258-4136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number88395
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP5146
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: