Provider Demographics
NPI:1033160262
Name:EVANS, NICOLE STOKER (DPT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:STOKER
Last Name:EVANS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:CHAUNTE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPT, CSCS
Mailing Address - Street 1:1710 W HORIZON RIDGE PKWY
Mailing Address - Street 2:STE 110
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4901
Mailing Address - Country:US
Mailing Address - Phone:702-489-9217
Mailing Address - Fax:702-489-9134
Practice Address - Street 1:1710 W HORIZON RIDGE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-4901
Practice Address - Country:US
Practice Address - Phone:702-489-9217
Practice Address - Fax:702-489-9134
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2003225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508879Medicaid
NVV102179Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER