Provider Demographics
NPI:1033837000
Name:DAVIS, ELIZABETH TRUDY (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:TRUDY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SPIRO
Mailing Address - State:OK
Mailing Address - Zip Code:74959-2456
Mailing Address - Country:US
Mailing Address - Phone:918-962-8009
Mailing Address - Fax:918-962-8027
Practice Address - Street 1:701 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SPIRO
Practice Address - State:OK
Practice Address - Zip Code:74959-2456
Practice Address - Country:US
Practice Address - Phone:918-962-8009
Practice Address - Fax:918-962-8027
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK209778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily