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General NPI Number Information
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NPI Number | 1740622497
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Entity Type | Individual
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Provider Name | RANDI L DAVIS APRN
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Gender | Female
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Dates
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Enumeration Date | 07/23/2013
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Last Update Date | 08/02/2019
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Provider Practice Location Address
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Address Line | 301 S BAY DR
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City | BAY
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State | AR
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Zip | 72411-9482
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Country | US
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Telephone | 870-770-1920
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Fax | 870-994-7488
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Provider Business Mailing Address
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Address Line | 101 W MAIN ST
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City | HARDY
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State | AR
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Zip | 72542-9566
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Country | US
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Telephone |
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Fax | 870-856-2133
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A003914
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License Number State | AR
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