Basic Information
| Provider Information | |||||||||
| NPI: | 1629512926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | MARK | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 311 CAMDEN ST | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105911615 | ||||||||
| FaxNumber: | 2105911635 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 CAMDEN ST STE 606 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782152016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102290688 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2016 | ||||||||
| LastUpdateDate: | 11/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP132695 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.