Provider Demographics
NPI:1124708599
Name:EVANS, MARY MICHELE (APRN PMHNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MICHELE
Last Name:EVANS
Suffix:
Gender:F
Credentials:APRN PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CHERRY TREE LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-3011
Mailing Address - Country:US
Mailing Address - Phone:810-407-0491
Mailing Address - Fax:
Practice Address - Street 1:311 JUDGES RD STE 4E
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3655
Practice Address - Country:US
Practice Address - Phone:910-791-6767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187505363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health