Provider Demographics
NPI:1437840352
Name:DAVIS, MEGAN MICHELLE (FNP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MICHELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:MICHELLE
Other - Last Name:ROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12740 HESPERIA RD STE B
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8306
Mailing Address - Country:US
Mailing Address - Phone:760-927-6722
Mailing Address - Fax:
Practice Address - Street 1:11919 HESPERIA RD
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-2158
Practice Address - Country:US
Practice Address - Phone:760-948-1454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily