Provider Demographics
NPI:1588106678
Name:DAVIS, MICHELLE (APRN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:314-543-6979
Mailing Address - Fax:314-364-6321
Practice Address - Street 1:118 TIGER DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:AR
Practice Address - Zip Code:72933-6013
Practice Address - Country:US
Practice Address - Phone:479-965-0806
Practice Address - Fax:479-965-0807
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARA004395363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics