MEDICARE: ELIZABETH R DAVIS RNP

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	363L00000X	Nurse Practitioner	P01332	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01332	OTHER	AR	RNP LICENSE

General Provider Information

NPI Number	:	1740296771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH R DAVIS RNP

Provider Business Mailing Address
First Line	:	25900 HUB RD
Second Line	:
City	:	PARON
State	:	AR
Zip	:	72122-9394
Country	:	US
Telephone Number	:	501-351-1868
Fax Number	:

Provider Business Practice Location Address
First Line	:	5600 W 12TH ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72204-1717
Country	:	US
Telephone Number	:	501-748-3333
Fax Number	:

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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