Provider Demographics
NPI:1386744704
Name:EVANS, BETH ANN (DO)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:EVANS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:22070 HIGHWAY 59
Practice Address - Street 2:SUITE C
Practice Address - City:ABITA SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70420-3606
Practice Address - Country:US
Practice Address - Phone:985-875-2828
Practice Address - Fax:985-892-4684
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202217207R00000X, 208000000X
LADO.000451207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2400801Medicaid
MS00351871Medicaid
MS00351871Medicaid