Provider Demographics
NPI:1396794723
Name:DAVIS, SUSAN A (FNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 FOURTH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71343-2027
Mailing Address - Country:US
Mailing Address - Phone:318-339-9901
Mailing Address - Fax:318-339-9941
Practice Address - Street 1:2801 FOURTH ST STE 2
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71343-2027
Practice Address - Country:US
Practice Address - Phone:318-339-9901
Practice Address - Fax:318-339-9941
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04515363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1623814Medicaid
LA1623814Medicaid