Provider Demographics
NPI:1912058041
Name:EVANS, JANELLE MORGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JANELLE
Middle Name:MORGAN
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PARKWAY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374
Mailing Address - Country:US
Mailing Address - Phone:765-983-3127
Mailing Address - Fax:
Practice Address - Street 1:1050 REID PKWY STE 325
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1161
Practice Address - Country:US
Practice Address - Phone:659-628-5517
Practice Address - Fax:765-962-2591
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35095645207VF0040X
OH95645207VG0400X
IN01093522A207VF0040X
MA229963207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35095645OtherLICENSE
OH3114427Medicaid
OHH229280Medicare PIN