Provider Demographics
NPI:1760575179
Name:EVANS, STEPHANIE CLAIRE (PHD, APRN, CPNP-PC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:CLAIRE
Last Name:EVANS
Suffix:
Gender:F
Credentials:PHD, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N RUFE SNOW DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-4226
Mailing Address - Country:US
Mailing Address - Phone:817-337-5503
Mailing Address - Fax:
Practice Address - Street 1:230 N RUFE SNOW DR
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-4226
Practice Address - Country:US
Practice Address - Phone:817-337-5503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP08195, RN304751208000000X
TXAP125780363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2643661Medicaid
OH000000585420OtherANTHEM BCBS OHIO
OH000000585420OtherANTHEM
OH421534506123OtherCARESOURCE
OH000000585420OtherANTHEM BCBS OHIO
OH421534506123OtherCARESOURCE