Provider Demographics
NPI:1487636460
Name:EVANS, SUSAN JANE (APRN, BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANE
Last Name:EVANS
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WHITEFORD WAY STE A
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-5800
Mailing Address - Country:US
Mailing Address - Phone:803-808-1800
Mailing Address - Fax:803-808-1164
Practice Address - Street 1:130 WHITEFORD WAY STE A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-5800
Practice Address - Country:US
Practice Address - Phone:803-808-1800
Practice Address - Fax:803-808-1164
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18394364SP0807X
NC043456163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2591197Medicare ID - Type Unspecified