Healthcare Provider Details

I. General information

NPI: 1770580656
Provider Name (Legal Business Name): FAY C EVANS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 W 10TH ST SUITE 100
SEDALIA MO
65301-2540
US

IV. Provider business mailing address

601 E 14TH ST P O BOX 1706
SEDALIA MO
65301-5972
US

V. Phone/Fax

Practice location:
  • Phone: 660-827-0015
  • Fax: 660-827-7425
Mailing address:
  • Phone: 866-678-5627
  • Fax: 660-827-3742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number135682
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: