Provider Demographics
NPI:1043253818
Name:DAVIS, ANN (ANP)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-2039
Mailing Address - Country:US
Mailing Address - Phone:314-409-4525
Mailing Address - Fax:
Practice Address - Street 1:500 E CENTER ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-2039
Practice Address - Country:US
Practice Address - Phone:314-409-4525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO074640363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425451101Medicaid
P28642Medicare UPIN
000080944Medicare ID - Type UnspecifiedST LOUIS NUMBER