Provider Demographics
NPI:1053329300
Name:DAVIS, CATHY ELAINE (FNP-BC, RN)
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:ELAINE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2147
Mailing Address - Country:US
Mailing Address - Phone:423-209-7090
Mailing Address - Fax:423-209-7088
Practice Address - Street 1:9-5 EAST THIRD STREET
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403
Practice Address - Country:US
Practice Address - Phone:403-209-7090
Practice Address - Fax:423-209-7088
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005795363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP60112Medicare UPIN