Provider Demographics
NPI:1598075574
Name:EVANS, REBECCA JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEAN
Last Name:EVANS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4630
Mailing Address - Country:US
Mailing Address - Phone:434-857-3600
Mailing Address - Fax:
Practice Address - Street 1:414 PARK AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4630
Practice Address - Country:US
Practice Address - Phone:434-857-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002542363A00000X
PAMA054610363A00000X
MI5601006324363A00000X
363AM0700X
VA0110006135363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical