Provider Demographics
NPI:1114042975
Name:DAVIS, BARBARA A (FNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
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 1:115 E COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ALVARADO
Mailing Address - State:TX
Mailing Address - Zip Code:76009-4313
Mailing Address - Country:US
Mailing Address - Phone:817-783-5895
Mailing Address - Fax:817-783-5896
Practice Address - Street 1:1811 HIGHWAY 287 N
Practice Address - Street 2:SUITE 150
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063
Practice Address - Country:US
Practice Address - Phone:817-473-3979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP112984363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176885501Medicaid
TX8Y1259OtherBCBS TX
TXAP112984OtherLICENSE
TXAP112984OtherLICENSE