Individual
DR. JACKIE L EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8902 N MERIDIAN ST, SUITE 230, INDIANAPOLIS, IN 46260-5382
(317) 581-8888
(317) 705-7178
Mailing address
8902 N MERIDIAN ST, SUITE 230, INDIANAPOLIS, IN 46260-5382
(317) 581-8888
(317) 705-7178
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01036256
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000219230
ANTHEM
IN
05
—
100121860
—
IN
01
—
1588657860
NPI
IN
Enumeration date
08/23/2005
Last updated
12/03/2012
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