Provider Demographics
NPI:1346820388
Name:DAVIS, DENISE LYNNE (PMHNP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LYNNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 HILL ST
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28630-1640
Mailing Address - Country:US
Mailing Address - Phone:828-781-6288
Mailing Address - Fax:
Practice Address - Street 1:1265 21ST ST NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-2971
Practice Address - Country:US
Practice Address - Phone:828-328-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014317363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health