Provider Demographics
NPI:1265298384
Name:EVANS, ALYSHA (FNTP)
Entity type:Individual
Prefix:
First Name:ALYSHA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:FNTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17919 MADDEN DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5181
Mailing Address - Country:US
Mailing Address - Phone:281-732-8013
Mailing Address - Fax:
Practice Address - Street 1:17919 MADDEN DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-5181
Practice Address - Country:US
Practice Address - Phone:281-732-8013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist