Provider Demographics
NPI:1477012862
Name:DAVIS, JOSHUA EDWARD (CRNA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:EDWARD
Last Name:DAVIS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 COUNTY ROAD 180
Mailing Address - Street 2:
Mailing Address - City:OVALO
Mailing Address - State:TX
Mailing Address - Zip Code:79541-2326
Mailing Address - Country:US
Mailing Address - Phone:931-308-5256
Mailing Address - Fax:
Practice Address - Street 1:1900 PINE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2432
Practice Address - Country:US
Practice Address - Phone:325-670-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9429423163WC0200X
FLAPRN11002479367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine