Healthcare Provider Details

I. General information

NPI: 1992338016
Provider Name (Legal Business Name): MATTHEW ALLEN EVANS DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8641 WILSHIRE BLVD STE 200
BEVERLY HILLS CA
90211-2920
US

IV. Provider business mailing address

8641 WILSHIRE BLVD STE 200
BEVERLY HILLS CA
90211-2920
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-9353
  • Fax: 833-687-1439
Mailing address:
  • Phone: 310-657-9353
  • Fax: 833-687-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95098652
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number23710
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1116551
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23710
License Number StateSC
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95028919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: