Provider Demographics
NPI:1962980797
Name:DAVIS, ALEXANDRIA ASHLEY (FNP-C)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:ASHLEY
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 1:820 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:ASHDOWN
Mailing Address - State:AR
Mailing Address - Zip Code:71822-4347
Mailing Address - Country:US
Mailing Address - Phone:870-898-4576
Mailing Address - Fax:870-455-4484
Practice Address - Street 1:820 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822-4347
Practice Address - Country:US
Practice Address - Phone:870-898-4576
Practice Address - Fax:870-455-4484
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005656363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR230845758Medicaid