Healthcare Provider Details

I. General information

NPI: 1891276648
Provider Name (Legal Business Name): FELICIA DAVIS-SMITH PMHNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/31/2024
Certification Date: 08/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 ILLINOIS AVE
JOPLIN MO
64804-2813
US

IV. Provider business mailing address

2615 ILLINOIS AVE
JOPLIN MO
64804-2813
US

V. Phone/Fax

Practice location:
  • Phone: 314-809-7256
  • Fax:
Mailing address:
  • Phone: 314-809-7256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2024035797
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2017017764
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: