Provider Demographics
NPI:1497562326
Name:EVANS, CHRISTIANNA ELIZABETH
Entity type:Individual
Prefix:
First Name:CHRISTIANNA
Middle Name:ELIZABETH
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 S 66TH ST APT 1004
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-7107
Mailing Address - Country:US
Mailing Address - Phone:732-814-4899
Mailing Address - Fax:
Practice Address - Street 1:6636 W SUNSET AVE STE A
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0971
Practice Address - Country:US
Practice Address - Phone:479-361-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR227668363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care