Provider Demographics
NPI:1316455504
Name:DAVIS, DEBORAH (NP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
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:PO BOX 751
Mailing Address - Street 2:
Mailing Address - City:HULBERT
Mailing Address - State:OK
Mailing Address - Zip Code:74441-0751
Mailing Address - Country:US
Mailing Address - Phone:772-339-0772
Mailing Address - Fax:918-772-3638
Practice Address - Street 1:124 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HULBERT
Practice Address - State:OK
Practice Address - Zip Code:74441-8902
Practice Address - Country:US
Practice Address - Phone:918-772-2879
Practice Address - Fax:918-772-1233
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK102939363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily