Provider Demographics
NPI:1366684193
Name:DAVIS, CONNIE A (APRN-BC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 W RUBY STREET
Mailing Address - Street 2:
Mailing Address - City:STEPHENS
Mailing Address - State:AR
Mailing Address - Zip Code:71764
Mailing Address - Country:US
Mailing Address - Phone:870-786-9114
Mailing Address - Fax:870-786-5530
Practice Address - Street 1:113 W RUBY STREET
Practice Address - Street 2:
Practice Address - City:STEPHENS
Practice Address - State:AR
Practice Address - Zip Code:71764
Practice Address - Country:US
Practice Address - Phone:870-786-9114
Practice Address - Fax:870-786-5530
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARATP000195363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily