=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891565669
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES DAVIS FNP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2024
-----------------------------------------------------
Last Update Date | 12/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3202 E GREENWAY RD STE 1401
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85032-4511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-405-6396
-----------------------------------------------------
Fax | 415-252-7176
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 875 W PECOS RD APT 2017
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85225-7607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-900-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | 327568
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------