Basic Information
Provider Information
NPI: 1255985214
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EVANS
FirstName: AARON
MiddleName: CHRISTOPHER
NamePrefix:  
NameSuffix:  
Credential: NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1100 REID PKWY
Address2: MEDICAL STAFF SERVICES
City: RICHMOND
State: IN
PostalCode: 473741157
CountryCode: US
TelephoneNumber: 7659358807
FaxNumber: 7659833219
Practice Location
Address1: 1100 REID PKWY
Address2: REID HOSPITAL & HEALTH CARE SERVICES
City: RICHMOND
State: IN
PostalCode: 473741157
CountryCode: US
TelephoneNumber: 7659833144
FaxNumber: 7659833038
Other Information
ProviderEnumerationDate: 07/29/2019
LastUpdateDate: 05/13/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/13/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X28191306AINN Nursing Service ProvidersRegistered Nurse 
363LF0000X71009287AINY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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