MEDICARE: CINNAMON RENIQUE DAVIS APRN, PMHNP, FNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP07885	LA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP70053762	WA
3	363LF0000X	Family Nurse Practitioner	AP07885	LA
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024195176	VA

Other Identifiers

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

General Provider Information

NPI Number	:	1679980148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CINNAMON RENIQUE DAVIS APRN, PMHNP, FNP-BC

Provider Business Mailing Address
First Line	:	3014 DAUPHINE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70117-6754
Country	:	US
Telephone Number	:	877-968-0068
Fax Number	:	877-968-0888

Provider Business Practice Location Address
First Line	:	3014 DAUPHINE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70117-6754
Country	:	US
Telephone Number	:	877-968-0068
Fax Number	:	877-968-0888

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

Provider Enumeration Date	:	07/16/2014
Last Update Date	:	01/19/2026

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