Provider Demographics
NPI:1467170050
Name:EVANS, RICKIESHA AMBREYANA (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:RICKIESHA
Middle Name:AMBREYANA
Last Name:EVANS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 MCMICHAEL AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-8205
Mailing Address - Country:US
Mailing Address - Phone:318-347-7876
Mailing Address - Fax:
Practice Address - Street 1:4231 MCMICHAEL AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71119-8205
Practice Address - Country:US
Practice Address - Phone:318-347-7876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA225740363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health