Provider Demographics
NPI:1962423368
Name:DAVIS, RENETTE (FNP)
Entity type:Individual
Prefix:MS
First Name:RENETTE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 AIRPORT RD NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-1606
Mailing Address - Country:US
Mailing Address - Phone:540-204-6050
Mailing Address - Fax:855-858-0464
Practice Address - Street 1:3823 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-3043
Practice Address - Country:US
Practice Address - Phone:540-344-4325
Practice Address - Fax:855-858-0464
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6609363LF0000X
VA0024170497363LF0000X
TNRN089429363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNS15360Medicare UPIN
TNP00403710Medicare PIN
TN3900907Medicare PIN