Mystical Evans, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN241432 Issued in GA

Practice address

1495 Hickory Flat Hwy Ste 100
Canton, GA 30115-4266

Phone

(678) 341-6360

Fax

(678) 626-7900

NPI assigned

Jul 15, 2022

Last updated

May 9, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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 GA

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

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Omni Virtual Health Care IncGroup PAC ID 2769883842, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northside Hospital Forsyth Hospital, Cumming, GA, CCN 110005
• Piedmont Hospital, Inc Hospital, Atlanta, GA, CCN 110083

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DIJIBA

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.

• Omni Virtual Health Care Inc

  • Internal Medicine Physician
  • Alpharetta, GA
  • NPI 1093381709
  Medicare reassignment Care Compare group NPD
• Southeast Medical Group, P.C.

  dba North Atlanta Primary Care, P.C.

  • Family Medicine Physician
  • Alpharetta, GA
  • NPI 1235296054
  Medicare reassignment NPD
• Advanced Joint Surgery Specialists, LLC

  • Orthopaedic Surgery Physician
  • Atlanta, GA
  • NPI 1477929206
  Medicare reassignment
• Georgia Woundcare MD LLC

  • Internal Medicine Physician
  • Cumming, GA
  • NPI 1063231645
  NPD (past)
• Physician First Health Network

  • Public Health or Welfare Agency
  • Alpharetta, GA
  • NPI 1598558181
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northside Hospital, Inc.

  dba Northside Hospital Forsyth

  • General Acute Care Hospital
  • Cumming, GA
  • NPI 1376574277
  Care Compare affiliation
• Piedmont Hospital, Inc

  dba Piedmont Hospital

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1962461681
  Care Compare affiliation

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

{
    "created_epoch": "1657843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1982338737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 459",
            "city": "COLBERT",
            "state": "GA",
            "postal_code": "306280459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1495 HICKORY FLAT HWY STE 100",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301154266",
            "telephone_number": "678-341-6360",
            "fax_number": "678-626-7900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "MYSTICAL",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-15",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN241432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aldo Espinoza, M.D.
• Etowah Eye Clinic, P.C.
• Etowah Regional Medical Services PC (Medical Associates of North Georgia)
• Cassidy Meghan Evans Windsor, DAT, ATC
• Laura Lovinggood Evans, MSN, NP-C
• Exos - Athletes Performance Arizona LLC
• Exos Ap Arizona, LLC
• Nnenna Ezeilo, M.D.
• Fairpricemd Inc (FairPriceLabs)
• Family First Vision Care Georgia PLLC (Pearle Vision)

• Family Nurse Practitioner in Canton, GA
• Providers in Canton, 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 May 9, 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.