Healthcare Provider Details

I. General information

NPI: 1932012648
Provider Name (Legal Business Name): TIFFANY DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 NORTHRIDGE DR E STE C
VAN BUREN AR
72956-6983
US

IV. Provider business mailing address

117 NORTHRIDGE DR E STE C
VAN BUREN AR
72956-6983
US

V. Phone/Fax

Practice location:
  • Phone: 479-474-4892
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR095311
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: