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General NPI Number Information
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NPI Number | 1811571110
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Entity Type | Individual
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Provider Name | MELODY LYNN EVANS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/12/2021
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Last Update Date | 05/12/2021
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Provider Practice Location Address
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Address Line | 1201 S BELMONT AVE STE 101
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City | OKMULGEE
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State | OK
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Zip | 74447-6351
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Country | US
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Telephone | 918-756-2800
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Fax | 918-756-2861
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Provider Business Mailing Address
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Address Line | 810 CEDAR LN
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City | OKMULGEE
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State | OK
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Zip | 74447-6400
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Country | US
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Telephone | 918-756-3276
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | F05210178
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License Number State | OK
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