Healthcare Provider Details

I. General information

NPI: 1184350647
Provider Name (Legal Business Name): MONICA DAVIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 PINOLA BRAXTON RD
BRAXTON MS
39044-4422
US

IV. Provider business mailing address

684 PINOLA BRAXTON RD
BRAXTON MS
39044-4422
US

V. Phone/Fax

Practice location:
  • Phone: 410-419-9114
  • Fax:
Mailing address:
  • Phone: 410-419-9114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number851904
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number906958
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: