Healthcare Provider Details

I. General information

NPI: 1467235002
Provider Name (Legal Business Name): TAMEKA ELAINE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 ROYAL MILL AVE APT 335
WAKE FOREST NC
27587-1686
US

IV. Provider business mailing address

901 ROYAL MILL AVE APT 335
WAKE FOREST NC
27587-1686
US

V. Phone/Fax

Practice location:
  • Phone: 832-978-4855
  • Fax:
Mailing address:
  • Phone: 832-978-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1155425
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5018723
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: