Healthcare Provider Details

I. General information

NPI: 1881408508
Provider Name (Legal Business Name): SHANEKA EVANS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280A REES ST
BREAUX BRIDGE LA
70517-4612
US

IV. Provider business mailing address

2730 BERGEN BAY LN
FRESNO TX
77545-1560
US

V. Phone/Fax

Practice location:
  • Phone: 337-294-0701
  • Fax:
Mailing address:
  • Phone: 281-906-3788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number240197
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1181107
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: