Healthcare Provider Details

I. General information

NPI: 1346820388
Provider Name (Legal Business Name): DENISE LYNNE DAVIS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 BUNKER HILL RD
WAXHAW NC
28173-4574
US

IV. Provider business mailing address

1025 BUNKER HILL RD
WAXHAW NC
28173-4574
US

V. Phone/Fax

Practice location:
  • Phone: 828-781-6288
  • Fax: 704-973-9142
Mailing address:
  • Phone: 828-781-6288
  • Fax: 704-973-9142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5014317
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: