Healthcare Provider Details

I. General information

NPI: 1760002364
Provider Name (Legal Business Name): ASHLEY SHANTE DAVIS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 7TH AVE
JASPER AL
35501-4377
US

IV. Provider business mailing address

1100 7TH AVE
JASPER AL
35501-4377
US

V. Phone/Fax

Practice location:
  • Phone: 205-302-9000
  • Fax: 205-596-2029
Mailing address:
  • Phone: 205-302-9000
  • Fax: 205-596-2029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-174113
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-174113
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: