Provider Demographics
NPI:1366497604
Name:EVANS, DEBORAH A (APRN,BC, FNP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:A
Last Name:EVANS
Suffix:
Gender:F
Credentials:APRN,BC, FNP
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:A
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1940 GARRETT DR
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-2741
Mailing Address - Country:US
Mailing Address - Phone:573-225-2442
Mailing Address - Fax:573-339-7887
Practice Address - Street 1:2441 MYRA DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5803
Practice Address - Country:US
Practice Address - Phone:573-803-0919
Practice Address - Fax:573-803-0879
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO121037363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00283737OtherRR MEDICARE
MO429387509Medicaid
MO823833269Medicare PIN
MOP00283737OtherRR MEDICARE