Provider Demographics
NPI:1447213814
Name:EVANS, MOLLY M (PA)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:M
Last Name:EVANS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:107 WEEKS DR
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-3929
Mailing Address - Country:US
Mailing Address - Phone:336-598-5480
Mailing Address - Fax:336-598-5482
Practice Address - Street 1:107 WEEKS DR
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-3929
Practice Address - Country:US
Practice Address - Phone:336-598-5480
Practice Address - Fax:336-598-5482
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103130363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1447213814Medicaid
NCNC4903AMedicare PIN
NCNC4903AMedicare PIN