MEDICARE: DR. JONATHAN L. EVANS DNP,PMHNP-BC

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	163WC0400X	Case Management Registered Nurse	59977	NM
2	101YM0800X	Mental Health Counselor	59977	NM
3	2084P0800X	Psychiatry Physician	59977	NM
4	364SP0810X	Child & Family Psychiatric/Mental Health Clinical Nurse Specialist	59977	NM
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	59977	NM
6	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	59977	NM
7	364SI0800X	Informatics Clinical Nurse Specialist	59977	NM
8	364SP0807X	Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist	59977	NM

General Provider Information

NPI Number	:	1225658081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN L. EVANS DNP,PMHNP-BC

Provider Business Mailing Address
First Line	:	706 WOODLAND AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79922-2040
Country	:	US
Telephone Number	:	915-330-8185
Fax Number	:

Provider Business Practice Location Address
First Line	:	706 WOODLAND AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79922-2040
Country	:	US
Telephone Number	:	915-330-8185
Fax Number	:

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

Provider Enumeration Date	:	04/22/2020
Last Update Date	:	04/22/2020

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