Healthcare Provider Details

I. General information

NPI: 1023851458
Provider Name (Legal Business Name): BREANNA FAITH DAVIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BREANNA FAITH YARBROUGH

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 FAIRFIELD DR
NEW ALBANY MS
38652-3107
US

IV. Provider business mailing address

118 FAIRFIELD DR
NEW ALBANY MS
38652-3107
US

V. Phone/Fax

Practice location:
  • Phone: 662-534-0898
  • Fax: 662-534-8905
Mailing address:
  • Phone: 662-534-0898
  • Fax: 662-534-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number918465
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907805
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: