Provider Demographics
NPI:1568578714
Name:EVANS, ROBERT B (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:B
Last Name:EVANS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:BOB
Other - Middle Name:NMN
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:28 WHITE BRIDGE RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-1499
Mailing Address - Country:US
Mailing Address - Phone:615-327-1515
Mailing Address - Fax:615-352-1428
Practice Address - Street 1:28 WHITE BRIDGE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1499
Practice Address - Country:US
Practice Address - Phone:615-327-1515
Practice Address - Fax:615-352-1428
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA517363AS0400X
TNPA-052363AS0400X
NC0001-01419363AS0400X
TXPA04435363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4190330OtherBLUECROSS BLUESHIELD
TN4190702OtherBLUECROSS BLUESHIELD-ASSISTANT AT SURGERY
TNPENDINGMedicaid
TX142872100OtherFIRST CARE
TX8N8208OtherBCBS
TX142872100OtherSOUTHWEST LIFE & HEALTH
TNPENDINGMedicaid
TX142872100OtherFIRST CARE
TX142872100OtherSOUTHWEST LIFE & HEALTH
TXP00217990Medicare ID - Type UnspecifiedRAILROAD MEDICARE