Healthcare Provider Details

I. General information

NPI: 1316455504
Provider Name (Legal Business Name): DEBORAH DAVIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E MAIN ST
HULBERT OK
74441-8902
US

IV. Provider business mailing address

PO BOX 751
HULBERT OK
74441-0751
US

V. Phone/Fax

Practice location:
  • Phone: 918-772-2879
  • Fax: 918-772-1233
Mailing address:
  • Phone: 772-339-0772
  • Fax: 918-772-3638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number102939
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: