Healthcare Provider Details

I. General information

NPI: 1366085953
Provider Name (Legal Business Name): MRS. ASHLEY P EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 AUSTIN AVE STE 25515
WACO TX
76701-2117
US

IV. Provider business mailing address

231 WOODHAVEN TRL
MC GREGOR TX
76657-4135
US

V. Phone/Fax

Practice location:
  • Phone: 254-230-4345
  • Fax: 706-243-4254
Mailing address:
  • Phone: 706-905-9327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number919501
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1060086
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: