MEDICARE: MS. CHASITY MONIQUE EVANS FNP-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	363LF0000X	Family Nurse Practitioner	22612	SC

General Provider Information

NPI Number	:	1972163863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHASITY MONIQUE EVANS FNP-C

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE FL 4
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2842
Country	:	US
Telephone Number	:	864-522-8611
Fax Number	:

Provider Business Practice Location Address
First Line	:	905 VERDAE BLVD STE 101
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-4098
Country	:	US
Telephone Number	:	864-990-1910
Fax Number	:	864-990-1911

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

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	06/08/2026

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