Provider Demographics
NPI:1306033600
Name:DAVIS, TANIEKA DONYEL (WHCNP)
Entity Type:Individual
Prefix:
First Name:TANIEKA
Middle Name:DONYEL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 CONOVER DR
Practice Address - Street 2:GRAND PRAIRIE WOMEN'S HEALTH CENTER
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1519
Practice Address - Country:US
Practice Address - Phone:214-266-3500
Practice Address - Fax:214-266-3535
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX661550363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196032008Medicaid
TX196032009Medicaid
TX196032007Medicaid
TX196032002Medicaid
TX196032004Medicaid
TX196032003Medicaid
TX8Y3040OtherBLUE CROSS BLUE SHIELD
TX196032005Medicaid
TX196032010Medicaid
TX196032006Medicaid
TX196032001Medicaid