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General NPI Number Information
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NPI Number | 1982194320
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Entity Type | Individual
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Provider Name | HENRY EDWARD DAVIS JR. APRN CNP
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Gender | Male
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Dates
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Enumeration Date | 05/11/2018
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 1100 SW 3RD ST
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City | MINCO
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State | OK
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Zip | 73059-3044
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Country | US
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Telephone | 405-320-9431
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Fax | 405-689-3008
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Provider Business Mailing Address
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Address Line | 1100 SW 3RD ST
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City | MINCO
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State | OK
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Zip | 73059-3044
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Country | US
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Telephone | 405-381-8380
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Fax | 405-689-3008
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 57710
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License Number State | OK
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