Healthcare Provider Details

I. General information

NPI: 1356967020
Provider Name (Legal Business Name): SHAY LINN DAVIS AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W MOUNT ELDEN LOOKOUT RD
FLAGSTAFF AZ
86001-3801
US

IV. Provider business mailing address

345 W MOUNT ELDEN LOOKOUT RD
FLAGSTAFF AZ
86001-3801
US

V. Phone/Fax

Practice location:
  • Phone: 928-606-3776
  • Fax:
Mailing address:
  • Phone: 928-606-3776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number242280
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP031649
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number242280
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number242280
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: