Provider Demographics
NPI:1629580048
Name:EVANS, GRETCHEN FENNELL (FNP)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:FENNELL
Last Name:EVANS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 HOLLY HILLS CT
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-3277
Mailing Address - Country:US
Mailing Address - Phone:706-202-0233
Mailing Address - Fax:
Practice Address - Street 1:1181 LANGFORD DR STE 104
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7242
Practice Address - Country:US
Practice Address - Phone:706-850-3444
Practice Address - Fax:706-850-3448
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN198578363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily