Provider Demographics
NPI:1689015034
Name:EVANS, ERIK (RN, NNP-BC)
Entity Type:Individual
Prefix:MR
First Name:ERIK
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:RN, NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 WAVERLY WAY
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008
Mailing Address - Country:US
Mailing Address - Phone:817-440-2774
Mailing Address - Fax:
Practice Address - Street 1:14 COUNTRY TRAIL CT
Practice Address - Street 2:
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-5834
Practice Address - Country:US
Practice Address - Phone:636-346-8361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010017616163W00000X
TX2010017616363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163W00000XNursing Service ProvidersRegistered Nurse