Healthcare Provider Details

I. General information

NPI: 1689228975
Provider Name (Legal Business Name): ANNA MARIE DAVIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 HIGHWAY 71 N
MENA AR
71953-8917
US

IV. Provider business mailing address

1661 AIRPORT RD STE D
HOT SPRINGS AR
71913-8184
US

V. Phone/Fax

Practice location:
  • Phone: 479-394-1500
  • Fax: 479-394-1525
Mailing address:
  • Phone: 501-625-7500
  • Fax: 501-625-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number120490
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: