Provider Demographics
NPI:1154737450
Name:DAVIS, BOBBY (AGNP-C)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:AGNP-C
Other - Prefix:
Other - First Name:BOBBY
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:2714 HAZY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-4388
Mailing Address - Country:US
Mailing Address - Phone:713-231-3990
Mailing Address - Fax:
Practice Address - Street 1:1302 N SHEPHERD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-3752
Practice Address - Country:US
Practice Address - Phone:713-885-9899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX594257363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5189143787OtherCERTIFIED MEDICAL EXAMINER