Provider Demographics
NPI:1770580656
Name:EVANS, FAY C (ARNP)
Entity type:Individual
Prefix:
First Name:FAY
Middle Name:C
Last Name:EVANS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 E 14TH ST
Mailing Address - Street 2:P O BOX 1706
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-5972
Mailing Address - Country:US
Mailing Address - Phone:866-678-5627
Mailing Address - Fax:660-827-3742
Practice Address - Street 1:3700 W 10TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2540
Practice Address - Country:US
Practice Address - Phone:660-827-0015
Practice Address - Fax:660-827-7425
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO135682363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO427941232Medicaid
MO500029741OtherPALMETTO GBA
P80743Medicare UPIN
MO500029741OtherPALMETTO GBA