Healthcare Provider Details

I. General information

NPI: 1235120445
Provider Name (Legal Business Name): DEBORAH REQUA DAVIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N GLASSFORD HILL RD
PRESCOTT VALLEY AZ
86314-2285
US

IV. Provider business mailing address

974 HOPE LN
CHINO VALLEY AZ
86323-6753
US

V. Phone/Fax

Practice location:
  • Phone: 928-777-7820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number265071
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: