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NPI Code Detail

MEDICARE: ANGELA C DAVIS NP

MEDICARE: ANGELA C DAVIS NP
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 Practitioner17755TN

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 : 1245678598
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA C DAVIS NP
Provider Business Mailing Address
First Line : PO BOX 26194
Second Line :
City : BELFAST
State : ME
Zip : 04915-2012
Country : US
Telephone Number : 865-584-4747
Fax Number : 833-908-0998
Provider Business Practice Location Address
First Line : 1018 HIGHWAY 321 N
Second Line :
City : LENOIR CITY
State : TN
Zip : 37771-6683
Country : US
Telephone Number : 865-986-4450
Fax Number : 833-908-2124
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2013
Last Update Date : 06/26/2023

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