Healthcare Provider Details

I. General information

NPI: 1477645752
Provider Name (Legal Business Name): DARLENE KAY DAVIS RN/ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 DALE AVE SPC 709
STANTON CA
90680-8014
US

IV. Provider business mailing address

10800 DALE AVE SPC 709
STANTON CA
90680-8014
US

V. Phone/Fax

Practice location:
  • Phone: 714-425-4868
  • Fax:
Mailing address:
  • Phone: 714-425-4868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number456956
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number456956
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number45695614415
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: