Provider Demographics
NPI:1851891659
Name:EVETT, MICHAEL TAYLOR (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TAYLOR
Last Name:EVETT
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:11001 CALLANISH PARK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-3600
Mailing Address - Country:US
Mailing Address - Phone:678-276-5019
Mailing Address - Fax:
Practice Address - Street 1:150 N ROADRUNNER PKWY
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:575-556-6440
Practice Address - Fax:575-556-6445
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant