Provider Demographics
NPI:1427417963
Name:DAVIS, DESHAYNA RENE (APRN)
Entity Type:Individual
Prefix:
First Name:DESHAYNA
Middle Name:RENE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 NICHOLASVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1431
Mailing Address - Country:US
Mailing Address - Phone:859-260-6348
Mailing Address - Fax:859-260-4350
Practice Address - Street 1:1740 NICHOLASVILLE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1431
Practice Address - Country:US
Practice Address - Phone:859-260-6348
Practice Address - Fax:859-260-4350
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9999363LF0000X
KY3010176363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily