Healthcare Provider Details

I. General information

NPI: 1912536269
Provider Name (Legal Business Name): DELAINA LARAE DAVIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH ST STE 2F
OKLAHOMA CITY OK
73104-5417
US

IV. Provider business mailing address

700 NE 13TH ST
OKLAHOMA CITY OK
73104-5004
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-7001
  • Fax: 405-271-3005
Mailing address:
  • Phone: 405-764-8066
  • Fax: 405-271-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number115246
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: