| Evolve Behavioral Health, Llc | |
|
2628 Hough Rd Florence AL 35630-1747 | |
| (256) 394-0880 | |
| Not Available |
| Full Name | Evolve Behavioral Health, Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 2628 Hough Rd, Florence, Alabama |
| Authorized Official Name and Position | Jessi Blackstock Tidwell (CO- OWNER) |
| Authorized Official Contact | 2563940880 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolve Behavioral Health, Llc 215 Melissa Dr Muscle Shoals AL 35661-4752 Ph: (256) 394-0880 | Evolve Behavioral Health, Llc 2628 Hough Rd Florence AL 35630-1747 Ph: (256) 394-0880 |
| NPI Number | 1316708993 |
|---|---|
| Provider Enumeration Date | 01/19/2024 |
| Last Update Date | 01/19/2024 |
| Medicare PECOS PAC ID | 9032559521 |
|---|---|
| Medicare Enrollment ID | O20240501001270 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316708993 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Evans N Mize |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831414358 PECOS PAC ID: 6709031750 Enrollment ID: I20160125001896 |
| Provider Name | Deborah A Tyson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164980017 PECOS PAC ID: 1355677741 Enrollment ID: I20190723001961 |
| Provider Name | Jessi Blackstock Tidwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013556356 PECOS PAC ID: 3476938606 Enrollment ID: I20220923001027 |
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