Provider Demographics
NPI:1942005020
Name:NESBIT-EVANS, TRISTA LYNN (MA00018619)
Entity type:Individual
Prefix:
First Name:TRISTA
Middle Name:LYNN
Last Name:NESBIT-EVANS
Suffix:
Gender:F
Credentials:MA00018619
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 ROSEWOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-2686
Mailing Address - Country:US
Mailing Address - Phone:360-556-1468
Mailing Address - Fax:
Practice Address - Street 1:1655 COOPER POINT RD SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5735
Practice Address - Country:US
Practice Address - Phone:360-352-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018619225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist