Provider Demographics
NPI:1942293154
Name:EVANS, REBECCA BERRIER (CNM, FNP-BC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:BERRIER
Last Name:EVANS
Suffix:
Gender:F
Credentials:CNM, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 MARTHA BERRY BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1625
Mailing Address - Country:US
Mailing Address - Phone:706-295-5331
Mailing Address - Fax:
Practice Address - Street 1:150 GENTILLY BLVD
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8522
Practice Address - Country:US
Practice Address - Phone:770-382-5611
Practice Address - Fax:770-382-8381
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN145456367A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA173206867NMedicaid
GA173206867LMedicaid
GA173206867MMedicaid
GA202I509933Medicare PIN
GA173206867NMedicaid
GA173206867LMedicaid