Provider Demographics
NPI:1275659468
Name:EVANS, CAROLYN PATRICIA (PA)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:PATRICIA
Last Name:EVANS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 E LOHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8267
Mailing Address - Country:US
Mailing Address - Phone:575-522-6806
Mailing Address - Fax:575-566-6445
Practice Address - Street 1:4407 E LOHMAN AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8267
Practice Address - Country:US
Practice Address - Phone:575-522-6806
Practice Address - Fax:575-566-6445
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2002-0012363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical