Provider Demographics
NPI:1043441173
Name:EVANS, LEAH (APN)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 W CLEBURN ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-1916
Mailing Address - Country:US
Mailing Address - Phone:501-952-0883
Mailing Address - Fax:
Practice Address - Street 1:112 W CENTER ST STE 200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-6073
Practice Address - Country:US
Practice Address - Phone:501-661-0720
Practice Address - Fax:501-325-7938
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR73494163W00000X
ARA003320363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse