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NPI Code Detail

MEDICARE: STACIA RENEE DAVIS FNP

MEDICARE: STACIA RENEE DAVIS FNP
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
1363L00000XNurse PractitionerR096409AR

General Provider Information

NPI Number : 1538015359
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACIA RENEE DAVIS FNP
Provider Business Mailing Address
First Line : 11201 NORTHFIELD CT
Second Line :
City : FORT SMITH
State : AR
Zip : 72916-9126
Country : US
Telephone Number : 479-227-0116
Fax Number :
Provider Business Practice Location Address
First Line : 11201 NORTHFIELD CT
Second Line :
City : FORT SMITH
State : AR
Zip : 72916-9126
Country : US
Telephone Number : 479-227-0116
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2026
Last Update Date : 03/05/2026

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Directions to “ STACIA RENEE DAVIS FNP” Practice Location

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