Provider Demographics
NPI:1750260048
Name:EVANS, JAELYN DEYVON
Entity type:Individual
Prefix:
First Name:JAELYN
Middle Name:DEYVON
Last Name:EVANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16909 LAKESIDE HILLS PLZ STE 114
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4652
Mailing Address - Country:US
Mailing Address - Phone:402-932-2211
Mailing Address - Fax:402-932-9002
Practice Address - Street 1:16909 LAKESIDE HILLS PLZ STE 114
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4652
Practice Address - Country:US
Practice Address - Phone:402-932-2211
Practice Address - Fax:402-932-9002
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker