Healthcare Provider Details

I. General information

NPI: 1699688416
Provider Name (Legal Business Name): RAQUEL DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 FARROW RD
MEMPHIS TN
38116-7118
US

IV. Provider business mailing address

1091 WILDLEAF CV
MEMPHIS TN
38116-5513
US

V. Phone/Fax

Practice location:
  • Phone: 901-279-6468
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number225877
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: