Provider Demographics
NPI:1285927723
Name:EVANS, TETYANA (PMHNP)
Entity type:Individual
Prefix:
First Name:TETYANA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:TETYANA
Other - Middle Name:
Other - Last Name:LEPLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2528 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-7203
Mailing Address - Country:US
Mailing Address - Phone:443-548-3733
Mailing Address - Fax:410-360-1675
Practice Address - Street 1:2528 MOUNTAIN RD STE 102-204
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-7203
Practice Address - Country:US
Practice Address - Phone:443-839-6928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR173941363LP0808X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD041988500Medicaid