Provider Demographics
NPI:1770126344
Name:EVANS, BERTRESEA WHITE (APRN, FNP, C)
Entity type:Individual
Prefix:MRS
First Name:BERTRESEA
Middle Name:WHITE
Last Name:EVANS
Suffix:
Gender:F
Credentials:APRN, FNP, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 E 70TH ST # 151
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5115
Mailing Address - Country:US
Mailing Address - Phone:972-946-4671
Mailing Address - Fax:
Practice Address - Street 1:1303 LINE AVE STE 600
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4638
Practice Address - Country:US
Practice Address - Phone:318-425-4500
Practice Address - Fax:318-425-3447
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208483363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily