Provider Demographics
NPI:1134485378
Name:EVANS, MILINDA (QBHP)
Entity Type:Individual
Prefix:
First Name:MILINDA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:QBHP
Other - Prefix:
Other - First Name:MILINDA
Other - Middle Name:
Other - Last Name:SHATWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHPP
Mailing Address - Street 1:823 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2914
Mailing Address - Country:US
Mailing Address - Phone:870-741-2960
Mailing Address - Fax:870-741-2965
Practice Address - Street 1:114 E CRANDALL AVE # B
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3628
Practice Address - Country:US
Practice Address - Phone:870-741-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR182030795Medicaid