Provider Demographics
NPI:1134954803
Name:DAVIS, COURTNEY (FNP-BS)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP-BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 E PHILLIPS AVE
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-5446
Mailing Address - Country:US
Mailing Address - Phone:918-817-9996
Mailing Address - Fax:
Practice Address - Street 1:2715 E PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-5446
Practice Address - Country:US
Practice Address - Phone:918-817-9996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK220016363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily