Provider Demographics
NPI:1740536176
Name:EVANS, DONNA MELLON (FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MELLON
Last Name:EVANS
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:MELLON
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9755 DOGWOOD RD STE 260
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7029
Mailing Address - Country:US
Mailing Address - Phone:404-450-0338
Mailing Address - Fax:
Practice Address - Street 1:9755 DOGWOOD RD STE 260
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7029
Practice Address - Country:US
Practice Address - Phone:404-450-0338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0990548-NP363LF0000X
TX8136363LF0000X
GARN151512363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8136OtherSTATE BOARD OF NURSING
CO39483363Medicaid
CO39483363Medicaid