Healthcare Provider Details

I. General information

NPI: 1467927939
Provider Name (Legal Business Name): PAMELA RENE EVANS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 S PRESTON RD STE 260
PROSPER TX
75078-9881
US

IV. Provider business mailing address

PO BOX 1041
PROSPER TX
75078
US

V. Phone/Fax

Practice location:
  • Phone: 469-715-3535
  • Fax:
Mailing address:
  • Phone: 903-946-1261
  • Fax: 469-715-3536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number878004
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP139190
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: