Healthcare Provider Details

I. General information

NPI: 1346048139
Provider Name (Legal Business Name): COURTNEY EVANS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 WASHINGTON ST
QUINCY MA
02169-5895
US

IV. Provider business mailing address

360 US HIGHWAY 1 BYP UNIT 102
PORTSMOUTH NH
03801-7105
US

V. Phone/Fax

Practice location:
  • Phone: 857-529-5220
  • Fax: 857-529-5422
Mailing address:
  • Phone: 603-410-6700
  • Fax: 603-319-8308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA101187
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: