Provider Demographics
NPI:1912598772
Name:DAVIS, MADDISON (FNP-C)
Entity type:Individual
Prefix:
First Name:MADDISON
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 COUNTY ROAD 1265
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-7431
Mailing Address - Country:US
Mailing Address - Phone:903-227-3974
Mailing Address - Fax:
Practice Address - Street 1:3900 JOE RAMSEY BLVD E STE 6
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7705
Practice Address - Country:US
Practice Address - Phone:903-455-1100
Practice Address - Fax:903-455-1114
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1029158363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1029158OtherNP LICENSE FROM TEXAS BON