Healthcare Provider Details

I. General information

NPI: 1841907714
Provider Name (Legal Business Name): JAVIER DAVIS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 11/01/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 WINTON BLOUNT LOOP
MONTGOMERY AL
36117-3507
US

IV. Provider business mailing address

2266 RICHMOND CIR
PELHAM AL
35124-1253
US

V. Phone/Fax

Practice location:
  • Phone: 256-384-8264
  • Fax:
Mailing address:
  • Phone: 919-757-8443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-131929
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: