Healthcare Provider Details

I. General information

NPI: 1508193780
Provider Name (Legal Business Name): TERESA YVETTE DAVIS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date: 05/20/2026
Reactivation Date: 06/29/2026

III. Provider practice location address

1111 CIRCLE DR
MONROE NC
28112-5834
US

IV. Provider business mailing address

1911 SILK POND DR
WAXHAW NC
28173-7348
US

V. Phone/Fax

Practice location:
  • Phone: 704-764-1818
  • Fax:
Mailing address:
  • Phone: 704-502-3046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0809225
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number116397
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: