Individual
LEANN NICOLE EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
404 MAIN ST, NEW AUGUSTA, MS 39462-0000
(601) 964-8391
(601) 964-8393
Mailing address
PO BOX 1729, HATTIESBURG, MS 39403-1729
(601) 545-8700
(601) 450-2493
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R880882
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07759844
—
MS
01
—
12771131
CAQH NUMBER
MS
Enumeration date
10/27/2014
Last updated
05/15/2015
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