Healthcare Provider Details

I. General information

NPI: 1174050447
Provider Name (Legal Business Name): MELODY JEAN EVANS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MELODY JEAN HIGGS

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 E CARROLL ST STE 101102
SALISBURY MD
21801
US

IV. Provider business mailing address

100 E CARROLL ST
SALISBURY MD
21801-5422
US

V. Phone/Fax

Practice location:
  • Phone: 410-912-5785
  • Fax:
Mailing address:
  • Phone: 800-749-5191
  • Fax: 800-749-5191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR177475
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: