Healthcare Provider Details

I. General information

NPI: 1043253818
Provider Name (Legal Business Name): ANN DAVIS ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E CENTER ST
TROY IL
62294-2039
US

IV. Provider business mailing address

500 E CENTER ST
TROY IL
62294-2039
US

V. Phone/Fax

Practice location:
  • Phone: 314-409-4525
  • Fax:
Mailing address:
  • Phone: 314-409-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number074640
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: