| Leann Nicole Evans, FNP-C | |
|
404 Main St, New Augusta, MS 39462-0000 | |
| (601) 964-8391 | |
| (601) 964-8393 |
| Full Name | Leann Nicole Evans |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner - Family |
| Location | 404 Main St, New Augusta, Mississippi |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033514591 | NPI | - | NPPES |
| 07759844 | Medicaid | MS | |
| 12771131 | Other | MS | CAQH NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | R880882 (Mississippi) | Primary |
| Entity Name | South Ridge Family Clinic Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1881930469 PECOS PAC ID: 7416194790 Enrollment ID: O20130503000339 |
| Mailing Address | Practice Location Address |
|---|---|
| Leann Nicole Evans, FNP-C Po Box 1729, Hattiesburg, MS 39403-1729 Ph: (601) 545-8700 | Leann Nicole Evans, FNP-C 404 Main St, New Augusta, MS 39462-0000 Ph: (601) 964-8391 |
Charlene Hicks, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 404 Main Street, New Augusta, MS 39462 Phone: 601-964-8391 Fax: 601-964-8393 | |
Latesha Rochelle Williams, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 309 Mcswain Rd, New Augusta, MS 39462 Phone: 601-402-0859 | |
Kimberly Lashaun Coke, NP-C Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 105 Thomas Lane, New Augusta, MS 39462 Phone: 601-606-0956 | |
Tracy Hennessey, CFNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 404 Main St, New Augusta, MS 39462 Phone: 601-964-8391 Fax: 601-964-8393 |