MEDICARE: MS. CRYSTAL MONIQUE DAVIS PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209025953	IL

General Provider Information

NPI Number	:	1528780392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CRYSTAL MONIQUE DAVIS PMHNP-BC

Provider Business Mailing Address
First Line	:	7777 W LINCOLN HWY STE A
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-9491
Country	:	US
Telephone Number	:	708-918-4488
Fax Number	:	217-910-0598

Provider Business Practice Location Address
First Line	:	7777 W LINCOLN HWY STE A
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-9491
Country	:	US
Telephone Number	:	708-918-4488
Fax Number	:	214-910-0598

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2022
Last Update Date	:	09/23/2024

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