Healthcare Provider Details

I. General information

NPI: 1609555846
Provider Name (Legal Business Name): BREANNA EVANS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 S SPRING ST
TUPELO MS
38804-4822
US

IV. Provider business mailing address

PO BOX 68
TUPELO MS
38802-0068
US

V. Phone/Fax

Practice location:
  • Phone: 662-584-5097
  • Fax:
Mailing address:
  • Phone: 662-584-5097
  • Fax: 662-495-4079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number906100
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: