Healthcare Provider Details

I. General information

NPI: 1578565727
Provider Name (Legal Business Name): IRIS J EVANS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14508 JAMES B WHITE HWY S
TABOR CITY NC
28463-8358
US

IV. Provider business mailing address

500 JEFFERSON ST
WHITEVILLE NC
28472-3634
US

V. Phone/Fax

Practice location:
  • Phone: 910-653-7000
  • Fax: 910-653-7004
Mailing address:
  • Phone: 910-653-7000
  • Fax: 910-653-7004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200228
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: