Provider Demographics
NPI:1578583209
Name:EVANS, ROY LEE JR (NNP-BC, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:LEE
Last Name:EVANS
Suffix:JR
Gender:M
Credentials:NNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7545 W REDBIRD RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-6253
Mailing Address - Country:US
Mailing Address - Phone:480-510-1599
Mailing Address - Fax:623-258-4136
Practice Address - Street 1:7545 W REDBIRD RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-6253
Practice Address - Country:US
Practice Address - Phone:480-510-1599
Practice Address - Fax:623-258-4136
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ88395363LN0000X
AZAP5146363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ868036Medicaid
AZZ169605Medicare PIN