Provider Demographics
NPI:1174050447
Name:EVANS, MELODY JEAN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:JEAN
Last Name:EVANS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:MELODY
Other - Middle Name:JEAN
Other - Last Name:HIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 E CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5422
Mailing Address - Country:US
Mailing Address - Phone:800-749-5191
Mailing Address - Fax:800-749-5191
Practice Address - Street 1:145 E CARROLL ST STE 101102
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-912-5785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR177475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily