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General NPI Number Information
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NPI Number | 1093243891
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Entity Type | Individual
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Provider Name | ANDREA DAVIS PMHNP-BC.
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Gender | Female
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Dates
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Enumeration Date | 05/24/2017
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 382 THAYER ST
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City | PROVIDENCE
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State | RI
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Zip | 02906-1558
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Country | US
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Telephone | 401-401-6487
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Fax | 401-648-0161
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Provider Business Mailing Address
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Address Line | 118 WARWICK AVE APT 1
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City | CRANSTON
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State | RI
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Zip | 02905-3563
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Country | US
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Telephone | 401-228-4291
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN55756
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN03752
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License Number State | RI
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