1760414866 NPI number — DR. ADELE KAREN EVANS MD

Table of content: DR. ADELE KAREN EVANS MD (NPI 1760414866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760414866 NPI number — DR. ADELE KAREN EVANS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANS
Provider First Name:
ADELE
Provider Middle Name:
KAREN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760414866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
533 BOLIVAR ST STE 566
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70112-1349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-568-4789
Provider Business Mailing Address Fax Number:
504-568-4460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 HENRY CLAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70118-5720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-896-9832
Provider Business Practice Location Address Fax Number:
505-896-9296
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  2006-00303 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207YP0228X , with the licence number: 305190 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03485845 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2449303 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5903942 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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