Healthcare Provider Details

I. General information

NPI: 1760568398
Provider Name (Legal Business Name): TEARSANEE CARLISLE DAVIS DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST DEPT OF FAMILY MEDICINE
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-2022
  • Fax: 601-815-2036
Mailing address:
  • Phone: 601-815-3992
  • Fax: 601-984-5583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR857403
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: