Provider Demographics
NPI:1952585564
Name:EVANS, WAKESHA T (PA-C)
Entity Type:Individual
Prefix:
First Name:WAKESHA
Middle Name:T
Last Name:EVANS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:WAKESHA
Other - Middle Name:T
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:5880 RIVERS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-6053
Mailing Address - Country:US
Mailing Address - Phone:843-725-4673
Mailing Address - Fax:843-725-1235
Practice Address - Street 1:5880 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-6053
Practice Address - Country:US
Practice Address - Phone:843-725-4673
Practice Address - Fax:843-725-1235
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical