Provider Demographics
NPI:1710652367
Name:CONNER, EVELYN CHRISTINA (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:CHRISTINA
Last Name:CONNER
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 GRAPEVINE MILLS PKWY UNIT 321
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-1991
Mailing Address - Country:US
Mailing Address - Phone:972-679-4942
Mailing Address - Fax:
Practice Address - Street 1:2440 TIMBER RIDGE DR STE 101
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5048
Practice Address - Country:US
Practice Address - Phone:972-618-3547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-14
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1016417363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics