Provider Demographics
NPI:1952818353
Name:EVANS, TERRI JEAN (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:JEAN
Last Name:EVANS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 94545
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72190-4545
Mailing Address - Country:US
Mailing Address - Phone:501-420-3703
Mailing Address - Fax:
Practice Address - Street 1:4601 JFK BLVD STE 94025
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7310
Practice Address - Country:US
Practice Address - Phone:501-420-3703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-07
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR076851163WC1500X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health