Provider Demographics
NPI:1730634478
Name:EVANS, ANDREA GRACIE I (PNP)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:GRACIE
Last Name:EVANS
Suffix:I
Gender:F
Credentials:PNP
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:GRACIE
Other - Last Name:EVANS
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:PNP
Mailing Address - Street 1:301 UNIVERSITY BLVD DEPT OF
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-5302
Mailing Address - Country:US
Mailing Address - Phone:409-772-1064
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BLVD DEPT OF PEDS
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0351
Practice Address - Country:US
Practice Address - Phone:409-772-1064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX884809363LP0200X
LAAP08986363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP08986OtherLICENSE NUMBER
TX884809OtherLICENSE NUMBER
TXAP131680OtherLICENSE NUMBER
LARN13082OtherLICENSE NUMBER