Provider Demographics
NPI:1043292931
Name:DAVIS, RHONDA P (FNP)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:P
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SCHOOL STREET EXT
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MS
Mailing Address - Zip Code:39345-2272
Mailing Address - Country:US
Mailing Address - Phone:601-683-3327
Mailing Address - Fax:601-683-3329
Practice Address - Street 1:109 SCHOOL STREET EXT
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345-2272
Practice Address - Country:US
Practice Address - Phone:601-683-3327
Practice Address - Fax:601-683-3329
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR703109363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1043292931OtherMEDICARE
500013293OtherRAILROAD MEDICARE
MS00116791Medicaid
MS1043292931OtherMEDICARE