MEDICARE: MRS. CARLISSA MARIE EVANS N.P.

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	363LF0000X	Family Nurse Practitioner	800411	TX
2	363L00000X	Nurse Practitioner	800411	TX
3	363LG0600X	Gerontology Nurse Practitioner	800411	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104114727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARLISSA MARIE EVANS N.P.

Provider Business Mailing Address
First Line	:	10300 N CENTRAL EXPY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-8600
Country	:	US
Telephone Number	:	469-634-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1715 TEXOMA PKWY
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-2613
Country	:	US
Telephone Number	:	903-487-0477
Fax Number	:	903-486-9844

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

Provider Enumeration Date	:	07/17/2011
Last Update Date	:	01/23/2026

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