Provider Demographics
NPI:1417668120
Name:EVANS, CRISTINA (APRN)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 LAURI LN
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4827
Mailing Address - Country:US
Mailing Address - Phone:318-572-0381
Mailing Address - Fax:
Practice Address - Street 1:4830 LINE AVE STE 302
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-1530
Practice Address - Country:US
Practice Address - Phone:318-379-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA227084363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health