Nicole Evans

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

1110 Edgewood Ave W
Jacksonville, FL 32208-6405

Phone

(904) 448-4700

NPI assigned

May 21, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2019

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gateway Community Services, Inc.

  • Community/Behavioral Health Agency
  • Jacksonville, FL
  • NPI 1356305338
  Medicare reassignment NPD
• Child Guidance Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jacksonville, FL
  • NPI 1629646450
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1326613431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5503 CARRERA PL",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322771435",
            "telephone_number": "321-795-3503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 EDGEWOOD AVE W",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322086405",
            "telephone_number": "904-448-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-21",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katrina L Evans
• Katrina N Evans, MSW
• Kendall Evans
• Kyra Evans
• Michael Evans, MD
• Oksana Evans, PA
• Rafina Evans, DNP
• Robert Frank Evans, M.ED,LIC SCH PSY RET
• Samantha Snyder Evans, PA
• Stephanie J Evans, RN

• Mental Health Counselor in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.