Provider Demographics
NPI:1841830627
Name:DAVIS, ADRIAN (PMHNP)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 S TACOMA WAY STE 407
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-4312
Mailing Address - Country:US
Mailing Address - Phone:888-948-6026
Mailing Address - Fax:
Practice Address - Street 1:5401 S TACOMA WAY STE 407
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-4312
Practice Address - Country:US
Practice Address - Phone:888-948-6026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61259015363LP0808X
CA95147506363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2220120Medicaid