Healthcare Provider Details

I. General information

NPI: 1326153198
Provider Name (Legal Business Name): TIMOTHY C DAVIS RN,PNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S PARK DR
BROWNWOOD TX
76801-5918
US

IV. Provider business mailing address

2330 BARBERRY DR
DALLAS TX
75211-1805
US

V. Phone/Fax

Practice location:
  • Phone: 325-646-0704
  • Fax: 325-646-1513
Mailing address:
  • Phone: 214-529-1859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number582080
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number582080
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number582080
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number582080
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: