Healthcare Provider Details

I. General information

NPI: 1932003613
Provider Name (Legal Business Name): CLARISA CORDOVA DAVILA APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4222 WENDOVER AVE STE 600
ODESSA TX
79762-5983
US

IV. Provider business mailing address

1310 NW 8TH ST
ANDREWS TX
79714-2805
US

V. Phone/Fax

Practice location:
  • Phone: 432-552-5656
  • Fax:
Mailing address:
  • Phone: 432-631-9876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1003793
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: