MEDICARE: SAMILYA EVANS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		OK

General Provider Information

NPI Number	:	1013744085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMILYA EVANS

Provider Business Mailing Address
First Line	:	5812 SE 87TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-6078
Country	:	US
Telephone Number	:	618-960-0272
Fax Number	:

Provider Business Practice Location Address
First Line	:	5812 SE 87TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-6078
Country	:	US
Telephone Number	:	618-960-0272
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	09/16/2024

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Directions to “ SAMILYA EVANS ” Practice Location

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