MEDICARE: OLIVIA DAVIS

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	APRN.CNP.0036675	OH
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN.456186	OH
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209.034936	IL
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	C-APN.0102498-C-NP	CO
5	163WP0808X	Psychiatric/Mental Health Registered Nurse	041.603054	IL

General Provider Information

NPI Number	:	1801639091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA DAVIS

Provider Business Mailing Address
First Line	:	179 CREEKSIDE GREEN DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-2880
Country	:	US
Telephone Number	:	740-502-4035
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 N ACADEMY BLVD STE 261
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1567
Country	:	US
Telephone Number	:	719-851-5647
Fax Number	:	888-520-6144

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

Provider Enumeration Date	:	06/14/2024
Last Update Date	:	03/06/2026

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Directions to “ OLIVIA DAVIS ” Practice Location

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