Healthcare Provider Details

I. General information

NPI: 1205764453
Provider Name (Legal Business Name): DAVIS ADVANCE CARE ADVOCACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CHATHAM RD STE N
SPRINGFIELD IL
62704-4188
US

IV. Provider business mailing address

3525 DEER RIDGE RD
GOREVILLE IL
62939-2417
US

V. Phone/Fax

Practice location:
  • Phone: 618-713-0818
  • Fax:
Mailing address:
  • Phone: 618-713-0818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CYNTHIA DAVIS
Title or Position: FNP-BC, ACHPN
Credential: DNP
Phone: 618-713-0818