Healthcare Provider Details

I. General information

NPI: 1861704538
Provider Name (Legal Business Name): TRAVONDA DAVIS PIRTLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRAVONDA MEKIA DAVIS PA-C

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 FRIST BLVD STE 712
HERMITAGE TN
37076-2061
US

IV. Provider business mailing address

5651 FRIST BLVD STE 712
HERMITAGE TN
37076-2061
US

V. Phone/Fax

Practice location:
  • Phone: 615-872-9966
  • Fax: 615-872-9967
Mailing address:
  • Phone: 615-872-9966
  • Fax: 615-872-9967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-02350
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2824
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: