Provider Demographics
NPI:1316601115
Name:DAVIS, REVA MANNETTE (FNP-C)
Entity Type:Individual
Prefix:
First Name:REVA
Middle Name:MANNETTE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16344 WALLISVILLE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049
Mailing Address - Country:US
Mailing Address - Phone:281-747-9700
Mailing Address - Fax:877-579-2697
Practice Address - Street 1:16344 WALLISVILLE
Practice Address - Street 2:SUITE 500
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049
Practice Address - Country:US
Practice Address - Phone:281-747-9700
Practice Address - Fax:877-579-2697
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056974363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily