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General NPI Number Information
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NPI Number | 1982218566
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Entity Type | Individual
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Provider Name | NAALA LATRICE DAVIS FNP
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Gender | Female
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 09/01/2020
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Provider Practice Location Address
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Address Line | 415 HIGHWAY 61
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City | SHAW
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State | MS
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Zip | 38773-9425
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Country | US
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Telephone | 662-754-2226
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 992
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City | GREENWOOD
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State | MS
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Zip | 38935-0992
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Country | US
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Telephone |
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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 | 27827
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 904015
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License Number State | MS
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