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NPI Code Detail

MEDICARE: VICKY LYNN DAVIS FNP

MEDICARE:   VICKY LYNN DAVIS  FNP
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
1363LF0000XFamily Nurse PractitionerC-APN.0000943-CNPCO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134171572
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICKY LYNN DAVIS FNP
Provider Business Mailing Address
First Line : 655 S CANFIELD
Second Line :
City : MESA
State : AZ
Zip : 85208-7440
Country : US
Telephone Number : 800-893-9698
Fax Number :
Provider Business Practice Location Address
First Line : 3960 E CHANDLER BLVD
Second Line :
City : PHOENIX
State : AZ
Zip : 85048-6284
Country : US
Telephone Number : 636-225-1630
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 09/12/2019

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