MEDICARE: SHIREA DAVIS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN0000025893	TN

General Provider Information

NPI Number	:	1124642491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIREA DAVIS FNP-C

Provider Business Mailing Address
First Line	:	4377 BARRYMOR DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-3119
Country	:	US
Telephone Number	:	901-262-0775
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 POPLAR AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-7241
Country	:	US
Telephone Number	:	901-472-4190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2020
Last Update Date	:	06/03/2020

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