Healthcare Provider Details

I. General information

NPI: 1265147003
Provider Name (Legal Business Name): NINA S DAVIS APRN PMHP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 COASTAL VILLAGE DR
BRUNSWICK GA
31520-1974
US

IV. Provider business mailing address

1391 KILDAIRE FARM RD # 1080
CARY NC
27511-5525
US

V. Phone/Fax

Practice location:
  • Phone: 866-559-9555
  • Fax:
Mailing address:
  • Phone: 202-352-1341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberRN1008379
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5018787
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number4704206128
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN1008379
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704206128
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number155605
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5018787
License Number StateNC
# 8
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberGAA-NP003855
License Number StateGA
# 9
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number155605
License Number StateNC
# 10
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5018787
License Number StateNC
# 11
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number119804
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: