Healthcare Provider Details

I. General information

NPI: 1174301238
Provider Name (Legal Business Name): JONICA DAVIS NBHWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19822 HERON SHADOW CT
RICHMOND TX
77407-4103
US

IV. Provider business mailing address

19822 HERON SHADOW CT
RICHMOND TX
77407-4103
US

V. Phone/Fax

Practice location:
  • Phone: 346-324-2406
  • Fax:
Mailing address:
  • Phone: 346-324-2406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3785810
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: