Regina Jonelle Evans, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

903672 Issued in MS

Practice address

112 W Peeler Ave
Shaw, MS 38773-8710

Phone

(662) 754-3301

Fax

(662) 754-3304

NPI assigned

Jan 8, 2020

Last updated

Aug 20, 2020By the provider in NPPES

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 MS

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: regina.evans.p1@direct.deltahc.nextgenshare.com

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

• Delta Medical Group

  • Emergency Medicine Physician
  • Greenville, MS
  • NPI 1790701134
  Medicare reassignment NPD
• Making Moves in the Community, Incorporated

  • Family Medicine Physician
  • Shaw, MS
  • NPI 1851884266
  Medicare reassignment NPD
• Shaw Family Medical, LLC

  dba Shaw Family Medical

  • Clinic/Center
  • Shaw, MS
  • NPI 1750642633
  Medicare reassignment NPD
• Shaw Family Medical, LLC

  dba Gough's Family Medical Clinic

  • Family Nurse Practitioner
  • Drew, MS
  • NPI 1043665532
  NPD
• Delta Physician Practices

  • Family Nurse Practitioner
  • Greenville, MS
  • NPI 1598086639
  NPD (past)

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

{
    "created_epoch": "1578441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597881600000",
    "number": "1609416544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1722 DAHLIA DR",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387017347",
            "telephone_number": "662-207-0806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 W PEELER AVE",
            "city": "SHAW",
            "state": "MS",
            "postal_code": "387738710",
            "telephone_number": "662-754-3301",
            "fax_number": "662-754-3304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "REGINA",
        "middle_name": "JONELLE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-08",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "903672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kim Davis, NP
• Naala Latrice Davis, FNP
• Delta Drugs Inc
• Kimberly Drake
• Dream Lab Drug and Alcohol Testing (Dream Lab Drug and Alcohol Testing (1))
• Forever Youthful Adult Educational and Recreational Center (Forever Youthful)
• Nora Cecelia Gough-Davis, FNP
• Gaby Laverne Johnson
• Key Behavior Solutions Consulting Group (KBS)
• Life Savers Assisted Living LLC

• Family Nurse Practitioner in Shaw, MS
• Providers in Shaw, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.