Healthcare Provider Details

I. General information

NPI: 1538322342
Provider Name (Legal Business Name): AMELIA MARIE DAVIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 NE TARA CIR
BLUE SPRINGS MO
64014-1843
US

IV. Provider business mailing address

1307 NE TARA CIR
BLUE SPRINGS MO
64014-1843
US

V. Phone/Fax

Practice location:
  • Phone: 816-229-8308
  • Fax:
Mailing address:
  • Phone: 816-223-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2008006817
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRTP-003571
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: