Provider Demographics
NPI:1073828802
Name:DAVIS, LANEITA R (NP)
Entity type:Individual
Prefix:
First Name:LANEITA
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 BOXWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-8538
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-261-7387
Practice Address - Street 1:360 E EH CRUMP BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38126-5394
Practice Address - Country:US
Practice Address - Phone:901-261-7387
Practice Address - Fax:901-261-7387
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR868500163W00000X
TN15148363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse