Provider Demographics
NPI:1174931877
Name:EVANKOVICH, SAMANTHA ANN (CAA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANN
Last Name:EVANKOVICH
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:MRS
Other - First Name:SAMANTHA
Other - Middle Name:ANN
Other - Last Name:YAKEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6431 FANNIN ST
Mailing Address - Street 2:SUITE 5.020
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:713-500-6202
Mailing Address - Fax:713-500-0648
Practice Address - Street 1:6431 FANNIN ST
Practice Address - Street 2:SUITE 5.020
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-6202
Practice Address - Fax:713-500-0648
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
367H00000X
IN75000023A367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001260391OtherANTHEM PTAN