Provider Demographics
NPI:1326041831
Name:DAVIS, WILLIAM G II (RN,CS,FNP-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:G
Last Name:DAVIS
Suffix:II
Gender:M
Credentials:RN,CS,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11768 MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-8585
Mailing Address - Country:US
Mailing Address - Phone:417-451-0282
Mailing Address - Fax:417-451-6277
Practice Address - Street 1:1706 SE WALTON BLVD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3200
Practice Address - Country:US
Practice Address - Phone:479-464-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2013-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN089423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MORN089423OtherRN LICENSE MISSOURI
MO425287109Medicaid
MORN089423OtherRN LICENSE MISSOURI