Healthcare Provider Details

I. General information

NPI: 1073204236
Provider Name (Legal Business Name): RACHEL ANN EVANS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 06/30/2025
Certification Date: 06/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12455 E 100TH ST N
OWASSO OK
74055-4674
US

IV. Provider business mailing address

205 N WILL ROGERS LOOP W
OOLOGAH OK
74053-6204
US

V. Phone/Fax

Practice location:
  • Phone: 405-757-7818
  • Fax: 405-703-0645
Mailing address:
  • Phone: 918-429-6130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number211645
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: