Provider Demographics
NPI:1043971898
Name:DAVIS, ALICIA PAIGE (DNP, CFNP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:PAIGE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DNP, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 8TH ST N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-4723
Mailing Address - Country:US
Mailing Address - Phone:662-573-4800
Mailing Address - Fax:833-673-1590
Practice Address - Street 1:219 8TH ST N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-4723
Practice Address - Country:US
Practice Address - Phone:662-610-4966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty