Provider Demographics
NPI:1366281404
Name:DAVIS, ANGELA ANITA (MSN, RN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:ANITA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:AHJANA
Other - Middle Name:ANIYA
Other - Last Name:BUCKLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:4010 OFERRAL ST STE 209
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1613
Mailing Address - Country:US
Mailing Address - Phone:601-689-5021
Mailing Address - Fax:
Practice Address - Street 1:4010 OFERRAL ST STE 209
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1613
Practice Address - Country:US
Practice Address - Phone:601-689-5021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS875005163WH1000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Multi-Specialty