Healthcare Provider Details

I. General information

NPI: 1205200516
Provider Name (Legal Business Name): BETH ANN DAVISON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N PLEASANT AVE
CENTRALIA IL
62801-3006
US

IV. Provider business mailing address

213 PALAZZO CIR
ST AUGUSTINE FL
32092-4504
US

V. Phone/Fax

Practice location:
  • Phone: 618-436-5665
  • Fax: 618-436-8042
Mailing address:
  • Phone: 406-493-4247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9470700
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN9470700
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: