MEDICARE: REBECCA JEAN EVANS PA-C

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	363A00000X	Physician Assistant	OA002542	PA
2	363A00000X	Physician Assistant	MA054610	PA
3	363A00000X	Physician Assistant	5601006324	MI
4	363AM0700X	Medical Physician Assistant
5	363A00000X	Physician Assistant	0110006135	VA

General Provider Information

NPI Number	:	1598075574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA JEAN EVANS PA-C

Provider Business Mailing Address
First Line	:	414 PARK AVE
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24541-4630
Country	:	US
Telephone Number	:	434-857-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 PARK AVE
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24541-4630
Country	:	US
Telephone Number	:	434-857-3600
Fax Number	:

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

Provider Enumeration Date	:	10/08/2010
Last Update Date	:	05/29/2020

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