Healthcare Provider Details

I. General information

NPI: 1134356553
Provider Name (Legal Business Name): CRESHA TANARA-TULANI DAVIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 PROFESSIONAL DR
WEST MONROE LA
71291-5332
US

IV. Provider business mailing address

122 PROFESSIONAL DR
WEST MONROE LA
71291-5332
US

V. Phone/Fax

Practice location:
  • Phone: 318-807-4611
  • Fax: 318-807-4615
Mailing address:
  • Phone: 318-807-4611
  • Fax: 318-807-4615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301099354
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD.208218
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number4301099354
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberMD208218
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberMD.208218
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: