Provider Demographics
NPI:1306671094
Name:ALFRED, EMMANUEL DAVIS (NP)
Entity type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:DAVIS
Last Name:ALFRED
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 S HAYFORD RD APT H103
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-9821
Mailing Address - Country:US
Mailing Address - Phone:214-909-2989
Mailing Address - Fax:
Practice Address - Street 1:2814 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2528
Practice Address - Country:US
Practice Address - Phone:214-909-2989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10000505363LP0808X
TX1176256363LP0808X
WAAP61609084363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health