Provider Demographics
NPI:1619907979
Name:WILLIAMS-EVANS, SHIPHRAH ALDORA ALICIA (PHD, APRN, BC)
Entity Type:Individual
Prefix:
First Name:SHIPHRAH
Middle Name:ALDORA ALICIA
Last Name:WILLIAMS-EVANS
Suffix:
Gender:F
Credentials:PHD, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 DE MOSS ST
Mailing Address - Street 2:
Mailing Address - City:LORDSBURG
Mailing Address - State:NM
Mailing Address - Zip Code:88045-2617
Mailing Address - Country:US
Mailing Address - Phone:918-991-5748
Mailing Address - Fax:
Practice Address - Street 1:3200 32ND STREET BYP
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7802
Practice Address - Country:US
Practice Address - Phone:575-597-2650
Practice Address - Fax:575-597-2651
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM59284363LP0808X
OK27532363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM96306068Medicaid
OK100768880IMedicaid
OK200509690AMedicaid
OK100768880IMedicaid
OK200509690AMedicaid