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General NPI Number Information
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NPI Number | 1568907376
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Entity Type | Individual
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Provider Name | MRS. ELIZABETH L EVANS
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Gender | Female
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Dates
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Enumeration Date | 01/03/2017
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Last Update Date | 01/03/2017
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Provider Practice Location Address
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Address Line | 840 N OAK AVE
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City | RULEVILLE
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State | MS
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Zip | 38771-3227
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Country | US
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Telephone | 662-756-1641
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Fax | 662-756-1696
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Provider Business Mailing Address
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Address Line | PO BOX 369 840 NORTH OAK AVE.
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City | RULEVILLE
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State | MS
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Zip | 38771-0369
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Country | US
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Telephone | 662-756-1641
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Fax | 662-756-1696
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 901870
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 901870
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License Number State | MS
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