Provider Demographics
NPI:1073549085
Name:DAVIS, STEPHANIE C (PHD, APRN, BC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:C
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 VARDRY ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3331
Mailing Address - Country:US
Mailing Address - Phone:864-233-0567
Mailing Address - Fax:864-241-0567
Practice Address - Street 1:413 VARDRY ST STE 1A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3331
Practice Address - Country:US
Practice Address - Phone:864-233-0567
Practice Address - Fax:864-241-0567
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2014-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN107264363L00000X
SC3084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00444628Medicare PIN
P59607Medicare UPIN
GA50BBHNZMedicare PIN