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General NPI Number Information
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NPI Number | 1891182853
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Entity Type | Individual
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Provider Name | DARRYL JEROME DAVIS NP
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Gender | Male
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Dates
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Enumeration Date | 04/16/2015
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 3516 NORTH BLVD STE B
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3674
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Country | US
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Telephone | 318-239-4860
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Fax | 805-295-4715
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Provider Business Mailing Address
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Address Line | PO BOX 4506
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City | SHREVEPORT
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State | LA
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Zip | 71134-0506
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Country | US
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Telephone | 318-239-4860
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Fax | 805-295-4715
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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 | 228926
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License Number State | LA
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