NPIMap

Individual provider Active NPI

Traci Evans, NP-C

  • Adult Health Nurse Practitioner
  • Gulfport, MS
National Provider Identifier
1982978771
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
R877630 Issued in MS
Practice address
4540 W Railroad St
Gulfport, MS 39501-2480
Phone
(228) 867-6062
Fax
(228) 867-2598
NPI assigned
Feb 27, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X R877630 MS Primary

Addresses

Primary practice location

4540 W Railroad St
Gulfport, MS 39501-2480

Mailing address

PO Box 1810
Gulfport, MS 39502-1810
Phone (228) 867-6062

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120418000272 MS Practitioner - Nurse Practitioner 3678734605 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians

Practice addresses (Care Compare)

4540 W Railroad St
Gulfport, MS 39501-2480
Phone (228) 867-6052

Hospital & facility affiliations

  • Memorial Hospital at Gulfport Hospital, Gulfport, MS, CCN 250019

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport Current Accepting new patients
The National Diabetes & Obesity Research Institute at Tradition, Missi CurrentSince Mar 15, 2020 Accepting new patients
Memorial Hospital at Gulfport CurrentSince Nov 26, 2019 Accepting new patients
Memorial Hospital at Gulfport Past Accepting new patients

Locations

19289C Saint Joseph St
Biloxi, MS 39532
Phone (228) 822-6052

9454 Three Rivers Rd
Ste A
Gulfport, MS 39503
Phone (228) 864-7747

1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856

4540 W Railroad St
Gulfport, MS 39501
Phone (228) 867-2598

Interoperability endpoints

  • Direct secure messaging: tevans@direct.mhg.com

Organizations & group practices 5

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.

Hospital & facility affiliations 60

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

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1330300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734393600000",
    "number": "1982978771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1810",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395021810",
            "telephone_number": "228-867-6062",
            "fax_number": "228-867-2598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4540 W RAILROAD ST",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012480",
            "telephone_number": "228-867-6062",
            "fax_number": "228-867-2598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "TRACI",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-27",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MS",
            "license": "R877630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.