Healthcare Provider Details

I. General information

NPI: 1194753962
Provider Name (Legal Business Name): SHARON R DAVIS FPMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON R JAMES

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 E CAPITOL ST 840 TRUST MARK BLDG
JACKSON MS
39201-2503
US

IV. Provider business mailing address

383 BRIARWOOD RD # 103
MERIDIAN MS
39305-9648
US

V. Phone/Fax

Practice location:
  • Phone: 800-632-6074
  • Fax: 866-341-7509
Mailing address:
  • Phone: 601-679-7763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR529656
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberR529656
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR529656
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: