Provider Demographics
NPI:1265147003
Name:DAVIS, NINA SIMONE (APRN PMHP-BC)
Entity type:Individual
Prefix:MISS
First Name:NINA
Middle Name:SIMONE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN PMHP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1391 KILDAIRE FARM RD # 1080
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5525
Mailing Address - Country:US
Mailing Address - Phone:202-352-1341
Mailing Address - Fax:
Practice Address - Street 1:1391 KILDAIRE FARM RD # 1080
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5525
Practice Address - Country:US
Practice Address - Phone:919-438-3464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX155605251B00000X
NC5018787363L00000X, 363LP0808X, 363LG0600X
NC155605163WA0400X
MI4704206128163WA2000X, 363LP0808X
TX119804363LP0808X
DCRN1008379163WP0000X, 163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No251B00000XAgenciesCase Management
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine