Provider Demographics
NPI:1720516727
Name:EVANS, HALEY BANKS (PA-C)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:BANKS
Last Name:EVANS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3451 RIVER PARK DR APT 1815
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-9588
Mailing Address - Country:US
Mailing Address - Phone:903-391-3516
Mailing Address - Fax:
Practice Address - Street 1:6100 HARRIS PKWY STE 345
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4134
Practice Address - Country:US
Practice Address - Phone:817-346-5960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant