Healthcare Provider Details

I. General information

NPI: 1891565669
Provider Name (Legal Business Name): CHARLES DAVIS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 E GREENWAY RD STE 1401
PHOENIX AZ
85032-4511
US

IV. Provider business mailing address

875 W PECOS RD APT 2017
CHANDLER AZ
85225-7607
US

V. Phone/Fax

Practice location:
  • Phone: 888-405-6396
  • Fax: 415-252-7176
Mailing address:
  • Phone: 215-900-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number327568
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: