Healthcare Provider Details

I. General information

NPI: 1013237163
Provider Name (Legal Business Name): HEATHER NICOLE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 NE 9TH ST
SMITHVILLE TX
78957-1025
US

IV. Provider business mailing address

4616 W HOWARD LN L
AUSTIN TX
78728-6300
US

V. Phone/Fax

Practice location:
  • Phone: 512-360-5272
  • Fax: 512-360-3060
Mailing address:
  • Phone: 512-324-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number724111
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP119076
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: