Provider Demographics
NPI:1811571110
Name:EVANS, MELODY LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:LYNN
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 1:810 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6400
Mailing Address - Country:US
Mailing Address - Phone:918-756-3276
Mailing Address - Fax:
Practice Address - Street 1:1201 S BELMONT AVE STE 101
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6351
Practice Address - Country:US
Practice Address - Phone:918-756-2800
Practice Address - Fax:918-756-2861
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKF05210178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine