Provider Demographics
NPI:1821493297
Name:EVANS, DOUGLAS HOUSEMAN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:HOUSEMAN
Last Name:EVANS
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CONLEY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DEER LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59722-8708
Mailing Address - Country:US
Mailing Address - Phone:406-415-6514
Mailing Address - Fax:
Practice Address - Street 1:100 GARNET WAY
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:MT
Practice Address - Zip Code:59756
Practice Address - Country:US
Practice Address - Phone:406-693-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126490363LP0808X
MTAPRN-LIC-128574363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3429516-01Medicaid
TX3429516-02Medicaid
TX3429516-02Medicaid