MEDICARE: MRS. WENDY DAVIS RN

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	163WC0400X	Case Management Registered Nurse	4212001	TX
2	171400000X	Health & Wellness Coach
3	171M00000X	Case Manager/Care Coordinator
4	163W00000X	Registered Nurse	706571	TX

General Provider Information

NPI Number	:	1427789247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WENDY DAVIS RN

Provider Business Mailing Address
First Line	:	18482 KUYKENDAHL RD STE 108
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-8123
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4014 FIR FOREST DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-4938
Country	:	US
Telephone Number	:	281-783-9114
Fax Number	:

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

Provider Enumeration Date	:	06/22/2022
Last Update Date	:	06/22/2022

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