Healthcare Provider Details

I. General information

NPI: 1578543997
Provider Name (Legal Business Name): DONNA KAY DAVIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 DUTCHMAN CT
ELKIN NC
28621-2237
US

IV. Provider business mailing address

PO BOX 1267
MOUNT AIRY NC
27030-1267
US

V. Phone/Fax

Practice location:
  • Phone: 336-835-5330
  • Fax: 336-835-5337
Mailing address:
  • Phone: 336-786-4522
  • Fax: 336-786-3752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number61706
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201053
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: