Provider Demographics
NPI:1548340078
Name:DAVIS, MARY B (APN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-3284
Mailing Address - Country:US
Mailing Address - Phone:931-296-2231
Mailing Address - Fax:931-295-4590
Practice Address - Street 1:725 HOLLY LN
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-3284
Practice Address - Country:US
Practice Address - Phone:931-296-2231
Practice Address - Fax:931-296-4590
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12127363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN12127OtherAPN
TN73818OtherRN