Healthcare Provider Details

I. General information

NPI: 1548756810
Provider Name (Legal Business Name): LAURA JEAN DAVIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S HOLLY AVE
COLLINS MS
39428-3894
US

IV. Provider business mailing address

701 S HOLLY AVE
COLLINS MS
39428-3894
US

V. Phone/Fax

Practice location:
  • Phone: 601-765-3180
  • Fax: 601-765-2808
Mailing address:
  • Phone: 601-765-3180
  • Fax: 601-765-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number902701
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: