Healthcare Provider Details

I. General information

NPI: 1922103019
Provider Name (Legal Business Name): TERESA F DAVIS APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 S NATIONAL AVE
SPRINGFIELD MO
65804-2217
US

IV. Provider business mailing address

PO BOX 802843
KANSAS CITY MO
64180-2843
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-5437
  • Fax:
Mailing address:
  • Phone: 417-269-5712
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number094561
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: