Provider Demographics
NPI:1609040526
Name:EVANS, STACY A
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:A
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 SHORES DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-6804
Mailing Address - Country:US
Mailing Address - Phone:504-457-2181
Mailing Address - Fax:504-457-2183
Practice Address - Street 1:4415 SHORES DR
Practice Address - Street 2:SUITE 208
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6804
Practice Address - Country:US
Practice Address - Phone:504-457-2181
Practice Address - Fax:504-457-2183
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker