Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 1-058261 | AL |
N | 363LG0600X | Nurse Practitioner - Gerontology | 1-058261 | AL |
N | 363LP2300X | Nurse Practitioner - Primary Care | 1-058261 | AL |
NPI | 1083033286 |
---|---|
Provider Name | John Evans JR. |
First Address | Dothan, AL 36301-3001 |
Second Address | Dothan, AL 36301-3001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2014 |
Last Update Date | 15/04/2014 |