Healthcare Provider Details

I. General information

NPI: 1770101594
Provider Name (Legal Business Name): BRITTNEY DAVIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E IDAHO ST STE 100
BOISE ID
83712-6202
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-338-0148
  • Fax: 208-336-4027
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-2032
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: