Kelli Lane Evans, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN241946 Issued in GA

Practice address

616 Ponder Place Dr
Evans, GA 30809-3116

Phone

(706) 421-7325

NPI assigned

Apr 4, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Southeastern Aesthetic Surgery, LLC

  • Plastic Surgery Physician
  • Evans, GA
  • NPI 1962793505
  NPD (past)

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

{
    "created_epoch": "1554336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1871055210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 SAWBUCK WAY",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308094895",
            "telephone_number": "478-951-2747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 PONDER PLACE DR",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308093116",
            "telephone_number": "706-421-7325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "KELLI",
        "middle_name": "LANE",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-04",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "SC",
            "license": "22711",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN241946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evans Mental Health Associates
• Evans Procedure Center, LLC
• Evans Rehabilitation Services, LLC (Lake Oconee Rehabilitation and Performance Center)
• Evans Signature Dentistry LLC
• Evans Urgent Care
• Extraordinary Homecare LLC
• Eyecare One Martinez LLC (Broome Family Eyecare)
• F&M Wellness LLC
• Family Physicians of Evans
• Jackleen Fan

• Family Nurse Practitioner in Evans, GA
• Providers in Evans, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.