Evans, Carlissa Marie

Evans, Carlissa Marie is an individual health care provider with primary practice located at 4545 Fuller Dr Ste 325 , Irving TX 75038-6530. She recently has 3 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Gerontology, Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Evans, Carlissa Marie can be contacted via phone (972) 870-5511.

Contact Information

Primary practice address
4545 Fuller Dr Ste 325 Irving TX 75038-6530
Phone: (972) 870-5511
Fax: (972) 870-5512
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X 800411 Texas
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 800411 Texas
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 800411 Texas

Profile Details

NPI number 1104114727
LBN Legal business name Evans, Carlissa Marie
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 17th, 2011
Last updated Dec 16th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1104114727 NPPES
Texas MEDICAID 288256502

Popular Providers