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NPI Code Detail

MEDICARE: MARY ANN EVANS MD

MEDICARE: MARY ANN EVANS MD
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
12084P0800XPsychiatry Physician7553MT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2260041543OTHERMTRAIL ROAD MEDICARE NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10000009931OTHERMTBLUE CROSS/SHIELD OF MONT

General Provider Information

NPI Number : 1649245937
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ANN EVANS MD
Provider Business Mailing Address
First Line : 160 HERITAGE WAY STE 102
Second Line :
City : KALISPELL
State : MT
Zip : 59901-3127
Country : US
Telephone Number : 406-758-3244
Fax Number : 406-758-5166
Provider Business Practice Location Address
First Line : 160 HERITAGE WAY STE 102
Second Line :
City : KALISPELL
State : MT
Zip : 59901-3127
Country : US
Telephone Number : 406-758-3244
Fax Number : 406-758-5166
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2006
Last Update Date : 01/21/2026

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Directions to “ MARY ANN EVANS MD” Practice Location

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