Healthcare Provider Details

I. General information

NPI: 1851891659
Provider Name (Legal Business Name): MICHAEL TAYLOR EVETT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N ROADRUNNER PKWY
LAS CRUCES NM
88011
US

IV. Provider business mailing address

11001 CALLANISH PARK DR
AUSTIN TX
78750-3600
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-6440
  • Fax: 575-556-6445
Mailing address:
  • Phone: 678-276-5019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: