Active NPI
Desiree Dawn Evans
- Licensed Practical Nurse
- Clarksburg, WV
National Provider Identifier
1083323356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 34592
- Practice address
- 2673 Davisson Run Rd
Clarksburg, WV 26301-6838 - Phone
- (681) 342-3200
- NPI assigned
- Nov 16, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 34592 | WV | Primary |
Addresses
Primary practice location
2673 Davisson Run Rd
Clarksburg, WV 26301-6838
Mailing address
2673 Davisson Run Rd
Clarksburg, WV 26301-6838
Phone (681) 342-3200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34592 | WV | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1668556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668556800000",
"number": "1083323356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2673 DAVISSON RUN RD",
"city": "CLARKSBURG",
"state": "WV",
"postal_code": "263016838",
"telephone_number": "681-342-3200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2673 DAVISSON RUN RD",
"city": "CLARKSBURG",
"state": "WV",
"postal_code": "263016838",
"telephone_number": "681-342-3200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "DESIREE",
"middle_name": "DAWN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-11-16",
"last_updated": "2022-11-16",
"certification_date": "2022-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "WV",
"license": "34592",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksburg, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.