Healthcare Provider Details

I. General information

NPI: 1104879329
Provider Name (Legal Business Name): VANESSA ANN DAVIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5818 WINCHESTER RD
MEMPHIS TN
38115-4711
US

IV. Provider business mailing address

2809 KIRBY RD STE 116
MEMPHIS TN
38119-8245
US

V. Phone/Fax

Practice location:
  • Phone: 901-590-2202
  • Fax: 901-433-9326
Mailing address:
  • Phone: 901-590-2202
  • Fax: 901-433-9326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA810172
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN7987
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: