Provider Demographics
NPI:1891276648
Name:DAVIS-SMITH, FELICIA (PMHNP-C)
Entity type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:
Last Name:DAVIS-SMITH
Suffix:
Gender:F
Credentials:PMHNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2813
Mailing Address - Country:US
Mailing Address - Phone:314-809-7256
Mailing Address - Fax:
Practice Address - Street 1:2615 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2813
Practice Address - Country:US
Practice Address - Phone:314-809-7256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017017764163W00000X
MO2024035797363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse