Individual
TIMOTHY J EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1301 S ADAMS ST, FULTON, MS 38843
(662) 862-4422
(662) 862-4244
Mailing address
3377 JOE WHEELER BROWN RD, FULTON, MS 38843-7245
(662) 790-4902
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R819687
MS
363LF0000X
Family Nurse Practitioner
AP09666
LA
363LF0000X
Family Nurse Practitioner
Primary
R819687
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP09666
BOARD OF NURSING
LA
Enumeration date
08/02/2006
Last updated
06/17/2021
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