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General NPI Number Information
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NPI Number | 1962201491
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Entity Type | Individual
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Provider Name | TANNER DAVIS
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Gender |
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Dates
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Enumeration Date | 03/08/2025
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Last Update Date | 03/08/2025
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Provider Practice Location Address
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Address Line | 8101 CLAYTON RD
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City | CLAYTON
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State | MO
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Zip | 63117-1103
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Country | US
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Telephone | 314-726-2124
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Fax |
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Provider Business Mailing Address
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Address Line | 4707 SNOW WHITE TER
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City | ALTON
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State | IL
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Zip | 62002-5829
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Country | US
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Telephone | 618-980-1210
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2025006202
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License Number State | MO
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