Healthcare Provider Details

I. General information

NPI: 1053880781
Provider Name (Legal Business Name): HEATHER DAWN DAVIS APRN,FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER D WILLIAMS

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4119 S WATER TOWER PL STE A
MOUNT VERNON IL
62864-6293
US

IV. Provider business mailing address

4119 S WATER TOWER PL STE A
MOUNT VERNON IL
62864-6293
US

V. Phone/Fax

Practice location:
  • Phone: 618-816-6006
  • Fax: 618-816-6005
Mailing address:
  • Phone: 618-816-6006
  • Fax: 618-816-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209018023
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: