Basic Information
| Provider Information | |||||||||
| NPI: | 1619907979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS-EVANS | ||||||||
| FirstName: | SHIPHRAH | ||||||||
| MiddleName: | ALDORA ALICIA | ||||||||
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| Credential: | PHD, APRN, BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 DE MOSS ST | ||||||||
| Address2: | |||||||||
| City: | LORDSBURG | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880452617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9189915748 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3200 32ND STREET BYP | ||||||||
| Address2: | |||||||||
| City: | SILVER CITY | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880617802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755972650 | ||||||||
| FaxNumber: | 5755972651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 08/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 59284 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 96306068 | 05 | NM | MEDICAID |