Provider Demographics
NPI:1760815179
Name:EVANS, SHRIEKA T
Entity Type:Individual
Prefix:
First Name:SHRIEKA
Middle Name:T
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 CYPRESS SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5109
Mailing Address - Country:US
Mailing Address - Phone:318-243-0436
Mailing Address - Fax:309-249-9312
Practice Address - Street 1:210 HIGHWAY 167 N
Practice Address - Street 2:
Practice Address - City:BERNICE
Practice Address - State:LA
Practice Address - Zip Code:71222-5117
Practice Address - Country:US
Practice Address - Phone:318-265-9902
Practice Address - Fax:309-249-9312
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07471363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health