Provider Demographics
NPI:1003321928
Name:DAVIS, NYKISHIA NICOLE (AGACNP-BC)
Entity Type:Individual
Prefix:MS
First Name:NYKISHIA
Middle Name:NICOLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51. N 39TH ST
Mailing Address - Street 2:MUTCH BUILDING 6TH FL M040
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:152-662-9798
Mailing Address - Fax:
Practice Address - Street 1:7725 RUGBY ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19150-2507
Practice Address - Country:US
Practice Address - Phone:267-973-2379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018345363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care