Provider Demographics
NPI:1184715484
Name:EVANS, LOANA EDITH (NP - C)
Entity type:Individual
Prefix:MRS
First Name:LOANA
Middle Name:EDITH
Last Name:EVANS
Suffix:
Gender:F
Credentials:NP - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 S FREMONT AVE
Mailing Address - Street 2:SUITE 4300
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2239
Mailing Address - Country:US
Mailing Address - Phone:417-820-3911
Mailing Address - Fax:417-820-3924
Practice Address - Street 1:2115 S FREMONT AVE
Practice Address - Street 2:SUITE 4300
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2239
Practice Address - Country:US
Practice Address - Phone:417-820-3911
Practice Address - Fax:417-820-3924
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN072421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
431560263OtherTRICARE WEST
MO242641702Medicaid
MO1184715484Medicaid
AR176559758Medicaid
P00709666OtherRAILROAD MEDICARE
2221OtherBLUE SHIELD
P00709666OtherRAILROAD MEDICARE
MO1184715484Medicaid