Provider Demographics
NPI:1740073162
Name:EVANS, MARY ROSE (FNP-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ROSE
Last Name:EVANS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 REEDY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-7733
Mailing Address - Country:US
Mailing Address - Phone:478-951-8576
Mailing Address - Fax:
Practice Address - Street 1:3951 RIDGE AVE STE B
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5063
Practice Address - Country:US
Practice Address - Phone:478-757-1934
Practice Address - Fax:478-757-1596
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN248141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily