Provider Demographics
NPI:1528257029
Name:EVANS, JEANNE (LMT)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 W HOPKINS ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-4379
Mailing Address - Country:US
Mailing Address - Phone:512-665-1939
Mailing Address - Fax:
Practice Address - Street 1:705 W HOPKINS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-4379
Practice Address - Country:US
Practice Address - Phone:512-665-1939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-20
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMTO26235174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist