Provider Demographics
NPI:1063009496
Name:DAVIS, OLIVIA CHRISTINE
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:CHRISTINE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9617 PAINTER DR
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-7119
Mailing Address - Country:US
Mailing Address - Phone:479-769-5566
Mailing Address - Fax:
Practice Address - Street 1:9617 PAINTER DR
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-7119
Practice Address - Country:US
Practice Address - Phone:479-769-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program