Provider Demographics
NPI: | 1336693159 |
---|---|
Name: | EVANS, MONTESHA SHERRELLE (FNP) |
Entity Type: | Individual |
Prefix: | MS |
First Name: | MONTESHA |
Middle Name: | SHERRELLE |
Last Name: | EVANS |
Suffix: | |
Gender: | F |
Credentials: | FNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 4003 |
Mailing Address - Street 2: | |
Mailing Address - City: | GASTONIA |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28054-0041 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 704-865-3525 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 708 S CHESTNUT ST |
Practice Address - Street 2: | |
Practice Address - City: | GASTONIA |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28054 |
Practice Address - Country: | US |
Practice Address - Phone: | 704-865-3525 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2016-08-10 |
Last Update Date: | 2022-04-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 5008804 | 363L00000X, 363LF0000X, 363LP0808X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |